RDCASA Registration form for Active Start and Fundamentals
Program you are registering for
Required
Registrant name
Your answer
Registrant date of birth
(day/month/year)
Your answer
Registrant age
Your answer
Registrant Address
(please include street address, city, province and postal code)
Your answer
contact information
(parent or aide name, phone number and email)
Your answer
Emergency contact information
(name, phone number and email of alternate person than parent or aide listed above)
Your answer
Provincial health number
Your answer
Doctors name and phone number
Your answer
Condition(s)
(please check all that apply) (this information is only collected to help in the design of the stations for our activities)
Required
Specifics of condition
(please let us know the specifics of how your childs condition relates to this class - limited attention, trouble with coordination, etc)
Your answer
Special notes
(if you or your child have specific concerns or conditions please let us know - sensitivity to light or noise, overwhelmed in large groups/spaces, etc)
Your answer
Mobility issues
(please let us know if your child uses or requires a wheelchair or other assistive device)
Your answer
Other medical conditions
(please let us know if your child or you have any other medical conditions we should be aware of - diabetes, epilepsy, heart condition, etc)
Your answer
Goals
What goals do you have for your child being in the program
Your answer
Release
Red Deer Childrens Adapted Sports Association (RDCASA) use the personal information collected on this form to establish your registration as an athlete; establish your eligibility to participate in our programs; communicate with you; ensure your health and safety needs and enable effective handling of medical emergencies. We will not share your personal information with anyone outside of our program and will keep all information housed securely to protect your information. At any time, if you wish to discontinue your relationship with us and have us remove your personal information from our database, please contact us. By signing below you understand that your participation in our programs is voluntary. We provide adapted sport activities for children based on sound practice and previous experience and training. At any time, should you have concerns, please contact us directly. By signing below you assume the inherent risk that comes from sport participation and will not hold liable RDCASA for injuries that result from your participation in our programs and activities.
Your answer
Consent to Photograph and Video
The Adapted Kinesiology program at RDC will video and photograph sessions on occasion as a learning tool for their students. The photos and videos are used during class lectures to identify learning situations and where improvements can be made by the students. The videos and photographs are never used for publication without express written consent by those in the picture or video. That would be an additional form, this form does not constitute that consent. By writing your name below (as the parent or aide of the child participating) you consent to the use of video and photography just as a learning activity for the Adapted Kinesiology students..
Your answer
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