U10A - Medical Form, U10A, A Teams (South Oxford Minor Hockey)

U10A - Medical Form

Player's Personal Information

Emergency Contacts

Doctor/Dentist Contacts

Medical History

Please check the appropriate response and provide details below if you answer “Yes” to any of the questions.

I understand that it is my responsibility to keep the team Safety Person advised of any change in the above information as soon as possible. In the event of a medical emergency and that no one can be contacted, team management will arrange to take my child to the hospital or a physician if deemed necessary. I hereby authorize the
physician and nursing staff to undertake examination, investigation and necessary treatment of my child. I also authorize release of information to appropriate people (coach, physician) as deemed necessary.

By accepting this acknowledgement digitally, you are providing your signature of agreement.

Disclaimer: Personal information used, disclosed, secured or retained by Hockey Canada will be held solely for the purposes for which we collected it and in accordance with the National Privacy Principles contained in the Personal Information Protection and Electronic Documents Act as well as Hockey Canada’s own Privacy Policy.