2026 Medical Form About YouAthlete Name(Required) First Last Date of Birth(Required) MM slash DD slash YYYY PhoneAddress(Required) Street Address Address Line 2 City Province AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Health Card Number(Required)Family Doctor(Required)Clinic Name(Required) Clinic Phone(Required)How Can We Reach You?In Case of EmergencyEmergency Contact(Required) First Last Phone(Required)Email(Required) Past Medical History(Required)Please indicate history of concussions, asthma, diabetic, allergies or other injuriesProof of Age(Required)Accepted file types: jpg, jpeg, png, gif.Picture of Health CardHead Coach(Required) Brandon McEachern Kay Szantos Claudia Klein Brittany Hawman Julie Langelier Allyson Heward Consent(Required) Cougar Volleyball Club – Medical Consent By checking this box, I authorize Cougar Volleyball Club staff and chaperones to seek and provide medical care for the athlete listed below in the event of an emergency. I confirm that the athlete has appropriate health insurance and that I have provided all relevant medical information.
