Medical Form - Kamloops Interior Dragons (KIDS)

* = Required Field

Name*

First Last

Address*

Mailing Address City Province Postal Code

Preferred Phone*

Birth Date*

PHN (Health #)*

Dr. Name

Dr. Phone

Emergency Contact*

Emergency Phone*

All participants must be double vaccinated for COVID-19 in order to participate in the 2022 paddling season. Vaccination passports and Government issued photo identification must be provided prior to your first practice.

I am double vaccinated for COVID-19:*

Yes
No

Health conditions (includes allergies, medications and any diagnoses).*

Medications carried on you*

Swim Level*

Any current, formal medical training

Consent*

I hereby authorize the person/persons in charge to secure such medical advice and services deemed necessary for my health and safety. I will advise the Club of any changes in my medical condition.

Date*

CAPTCHA

This form will be brought on the boat during every practice and festival.

2022Mar12 - Medical Form