Part 2: Emergency Details & Options

Player Data

Your Name

Email Address

Suite/Unit#

Street

City

Province/State

Postal Code

Country

Date of Birth

Gender at Birth

Add-ons & Options

Are you subbing in for another paid player? Are you subbing in for another paid player? YesNo

First name of paid player

Last name of paid player

Were you referred by someone to register here?Were you referred by someone to register here?YesNo

Referrer first name

Referrer last name

Referrer email

Referrer phone number

Lessons and drills are available by request; those interested will be contacted with more information.

I am interested in lessons and drills

Emergency Details

Emergency contact name

Emergency phone

Emergency contact relation

Any current injuries or limitations that may affect participation?

Any known medical conditions?

Do you use medication as needed? Example: Inhaler, EpiPen or other (If yes, please indicate the medication below)Do you use medication as needed? Example: Inhaler, EpiPen or other (If yes, please indicate the medication below)YesNo

Will you need assistance when using any of the said medication as needed?Will you need assistance when using any of the said medication as needed?YesNo

Medication used

How did you hear about us?

News and updates via emailNews and updates via emailI would like to receive event and product discounts via email.

Other way you've heard about us

DARE to LOVE Sports

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Contact

Get in Touch

daretolovesportsclub@yahoo.com

416-712-9992 (Text only)

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