Information form Halifax 15s Academy
Keltics Academy
Name *
Your answer
Phone Number*
Your answer
Health Card Number *
Your answer
Health Card Expiry Date *
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Emergency Contact #1 (Name, Relationship, Phone #, Email) *
Your answer
Emergency Contact #2 (Name, Relationship, Phone #, Email) *
Your answer
Medical Conditions and/or Medications *
Your answer
Past or Current Injuries *
Your answer
Allergies *
Your answer
Dietary Requirements *
Preferred morning training times Located at the CSC Atlantic (Canada Games Centre)
If you do not get your preferred time, will you be able to attend the second option?
Reason for joining the academy?
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Last team played for?
Your answer
What Keltics team are you looking to play for this year?
Your answer
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