This form is designed to collect important health and emergency information for all club members. The details provided will help club organizers, coaches, or staff ensure the safety and well-being of participants during all club activities, events, and trips.

Please complete all sections accurately and honestly. The information will be kept strictly confidential and used only in the event of a medical emergency or when necessary to support the member’s health and safety.

By submitting this form, you consent to the club’s authorized personnel having access to this information as needed during club activities.