Team Alberta Medical Information Sheet

Welcome to the Team Alberta program. 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 online approval. Please enter an email address for the athlete and parent/guardian. When SUBMIT is clicked, each individual will be emailed a weblink and access code. Athlete and parent/guardian must complete the approval fields, and submit. Submission constitutes authorization to act, and certification that the information in this form is accurate and complete.

2019 Alberta Cup 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)