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Alberta Provincial Championships (APC) - 2025
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Player Registration and Health Form
Part 1:
Applicant's Name *
Email address *
Telephone *
Home Address *
City *
Province *
Team *
Age Category *
55+
60+
65+
70+
75+
Medical Card Number *
Date of Birth (yyyy-mm-dd) *
Prescribed Medications *
Allergies *
Emergency Contact Person *
Contact Person's Phone number *
Relationship to Applicant *
Acknowledgement *
By submission of this form, I acknowledge that the information in this form is accurate, and I am aware that anyone submitting misleading or false documentation may be subject to disciplinary action, which could result in a suspension from this or future tournaments.
Authorized use of information in this form *
I authorize the use of the information contained in this form for use in an emergency by appropriate personnel.
Destruction of the information contained in this form. *
I authorized the destruction of this form by the Organization Committee at the end of this tournament.
Leave this field empty
Submit
Part 2:
Name *
Email address *
Send acknowledgement to my Manager *
I will send a copy of the email you will be sending to me to my team manager, acknowledging that I have completed this form.
Leave this field empty
Submit
