Individual Registration and Health Form

Individual Registration and Health Form

Please fill out your personal and health information below. Please submit before January 30th, 2026.
Registration Information
Participants Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Phone Number*
Please enter a valid phone number.
Email Address*
example@example.com
Address*

Street Address

Street Address Line 2

CityProvince

Postal Code
Please let us know if you plan to attend the Friday night Mixer as space is limited.*

NoYes, just myselfYes, with my spouse or companion
Tournament Division*
Team Name: If not in list please contact us using the contact us form
Health Form
I acknowledge that*

I am solely responsible for my own medical, liability and personal insurance.
Do you have any allergies or special needs? (none, glutens, etc.)
Do you have any chronic illnesses or medical conditions? (eg. nene, Diabetes, Heart)
Are you currently taking any medications? ( eg: none, heart - name drug)
Family Doctor's Name*

First NameLast Name
Doctor's Phone Number*
Please enter a valid phone number.
Emergency Contact Name*

First NameLast Name
Emergency Contact Phone Number*
Please enter a valid phone number.
Relationship
Use of this Document*

The information on this form will be kept under strick control and only made available to emergency personnel. By submitting this form, I authorize it's use by emergency personnel and it's destruction by the organizing committee after completion of this tournament.
Should be Empty:

Registration Information