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CMC Membership Application
Please complete and submit this form to join the Cambridge Multisport Club for the 2023 Season
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Name
*
Your answer
Email
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Your answer
Address
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Your answer
Mobile Phone number
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Your answer
Gender
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Male
Female
Birth date
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DD
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YYYY
Emergency Contact
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Your answer
Emergency Contact phone number
*
Your answer
Medical history, allergies or anything that our Coaches should be aware of (privacy of your information is respected and confidential)
Your answer
Have you experience ANY of the following within the past six months?
A diagnosis of/treatment for heart disease or stroke, or pain/discomfort/pressure in your chest during activities of daily living or during physical activity?
A diagnosis of/treatment for high blood pressure (BP), or a resting BP of 160/90 mmHg or higher?
Dizziness or light-headedness during physical activity?
Shortness of breath at rest?
Loss of consciousness/fainting for any reason?
Concussion
Do you currently have pain or swelling in any part of your body (such as from an injury, acute flare-up of arthritis, or back pain) that affects your ability to be physically active?
Yes
No
Clear selection
Has a health care provider told you that you should avoid or modify certain types of physical activity?
Yes
No
Clear selection
Do you have any other medical or physical condition (such as diabetes, cancer, osteoporosis, asthma, spinal cord injury) that may affect your ability to be physically active?
Yes
No
Clear selection
If yes, I have consulted a health care provider or Qualified Exercise Professional (QEP) who has recommended that I become more physically active
Yes
No
Clear selection
If yes, I am comfortable with becoming more physically active on my own without consulting a health care provider or QEP.
Yes
No
Clear selection
Have you competed in a Triathlon before? If yes, select which distance(s).
Try-a-Tri
Sprint
Olympic
Half Ironman
Full Ironman
By checking this box, you are agreeing to receive emails from Cambridge Multisport Club.
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I have read and agree to the Cambridge Multisport Club rules, waiver, release and indemnification agreement detailed at
https://www.cambridgemultisport.ca/join-us/waiver
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