Peewee Prospects Medical Information Sheet

Welcome to the Team Alberta program and the 2019 Alberta Challenge. We take the health and safety of each of our participants very seriously.

The following Medical Information Sheet must be filled out completely and truthfully. Any medical condition or injury MUST be checked by your physician before participating in a hockey program. It is the responsibility of each player and his/her parents/guardians to keep the team management advised of any change in the above information as soon as possible.

NOTE: In lieu of physical signatures on this form, authorization to act and certification of the accuracy of the information in provided via checkbox verification for both athlete and parent/guardian. If would like a copy of the form, please enter your email address in the field at the very bottom of the form.

2019 Peewee Prospects Medical Information Sheet

Required Fields *


Player Information

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Parent/Emergency Contacts

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Medical Information

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General Health Questions



Head Injuries/ Concussions



Neck Injuries/ Burners/ Stingers



Other Injuries

Check at least one of the following:

















Parent/Guardian Authorizations



Athlete Verification



Forward Submission

If you wish to forward this form submission to other related person(s) please enter their email addresses below, separated by commas. (ex: info@example.com,person2@example.com)