Osprey Minor Hockey -HDCO Medical Information Sheet (Osprey Minor Hockey)

Contact Information

Player First Name^*

Required

Player Last Name^*

Required

Player Date of Birth^*

Required

Player Street Address^*

Required

Postal Code^*

Required

Parent/Guardian Contact #1 Name^*

Required

Parent/Guardian Contact #1 - Phone^*

Required

Example: ###-###-####

Parent/Guardian Contact #2 - Name^*

Required

Parent/Guardian Contact #2 - Phone #^*

Required

Example: ###-###-####

Alternate Emergency Contact^*

Required

Alternate Emergency Contact Relationship to Player^*

Required

Alternate Emergency Contact Phone #^*

Required

Example: ###-###-####

Doctor's Name^*

Required

Doctor's Phone #^*

Required

Example: ###-###-####

Dentists Name^*

Required

Dentist Phone #^*

Required

Example: ###-###-####

Please Select Your Team^*

Required

I understand that it is my responsibility to keep the team Safety Person advised of any change in the above information as soon as possible. In the event of a medical emergency and that no one can be contacted, team management will arrange to take my child to the hospital or a physician if deemed necessary. I hereby authorize the physician and nursing staff to undertake examination, investigation and necessary treatment of my child. I also authorize release of information to appropriate people (coach, physician) as deemed necessary^*

Osprey Minor Hockey -HDCO Medical Information Sheet (Osprey Minor Hockey)

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Contact Information

Medical Info

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