Mountain Sports Registration
First Name *
Your answer
Last Name *
Your answer
Western Student ID # *
Your answer
Phone Number *
Preferably Cell Phone
Your answer
Western Email Address *
Pleas only enter your Western email and check it often to stay up to date
Your answer
Birthday *
MM
/
DD
/
YYYY
Gender *
Year in school *
Are you currently certified to drive Western vehicles? *
Have you taken the course at transportation services and submitted the appropriate paperwork?
Is the Mountain Sports Program the main reason you chose to attend Western? *
Emergency Contact
Please enter the contact information for the person that you would like to be notified in the event of an emergency.
Emergency Contact Name *
First and Last
Your answer
Primary Phone Number *
Your answer
Secondary Phone Number
Your answer
Insurance and Health History
Regardless of you answer, please complete all of the attached forms.
Do you currently have medical insurance coverage? *
Do you currently have any medical concerns and/or considerations, allergies, or medication needs that may inhibit or be exacerbated by your participation in Mountain Sports activities? *
Medical Concerns Explained
Your answer
Discipline Selection
Please review the disciplines below and select the teams that you would like to join.
Main Discipline *
Second Discipline
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