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RETURNING CADET REGISTRATION - NLCC VICE ADMIRAL KINGSMILL
Registration for cadets returning to NLCC Vice Admiral Kingsmill
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Email *
Surname, First Name *
Current rank *
Gender *
Date of Birth *
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City of Birth & Country *
Name of Primary Parent or Guardian (surname, first name) *
Relationship to Cadet *
Phone Number (Cell) *
E-mail Address *
Street Address, Town, Postal Code *
Alternate Phone (home, cell) if different from above
Name of other Parent or Guardian
Relationship to Cadet
Cell Phone
E-mail Address
Address (if different from above)
Alternate Contact Person (not the same as either above and local to cadet) *
Relationship to Cadet *
Street Address, Town, Postal Code *
Home / Cell Phone *
E-mail Address *
Personal emergency notification contact - first person to be notified (must be previously listed above) *
As parent/guardian, do you authorize the Navy League of Canada to exchange/release information in the event that the applicant suffers an injury, illness or death to any medical facility or medical professional for the purpose of providing medical care? *
Name of Family Doctor *
Doctor Phone Number *
Provincial Health Care (Number and Province) *
Provincial Health Card Expiry Date *
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Medical Insurance (name)
Medical Insurance Group, Policy and Dependant Numbers
Last Tetanus Injection (date)
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If any restrictions are listed (dietary, allergies, etc), does the parent/guardian consent to the above named cadet participating in training and activities which he/she will have a meal under the conditions described by the Navy League of Canada Statements above? *
Is the cadet presently on medication? *
THE NAVY LEAGUE OF CANADA CADET MEDICAL QUESTIONNAIRE- Regarding food allergies, it is important for parents/guardians to be aware that the Navy League of Canada and their Corps do not have the mandate, are not equipped or staffed to offer allergen-free food, or food preparation conditions. These limitation apply to meals and snacks prepared just as much by a caterer, volunteers or parents, and for all types of programs, courses and activities conducted throughout the year, whether locally or away. The Navy League of Canada is concerned that for those with food allergies, sensitivities and intolerance it may not always be safe to participate in all training and activities. Please acknowledge. *
Required
MEDICATIONS - Parents/guardians are to make the Commanding Officer or Medical Officer aware of any medications that their child may bring and that they may require during extended activities. The medications MUST be in original containers, preferably bubble packs, with the name, drug and dosage clearly labeled. Cadets who require an inhaler or EpiPen will need to carry them at all times in an appropriate fanny pack or other carry case. They should also make the staff aware of any health concerns that may impact their health and safety, or that of others. *
Required
Please indicate either "YES" or "NO" that applies to your cadet for each condition below *
YES
NO
Nervous trouble or breakdown
Head injury, concussion or headaches
Dizzy or fainting spells
Convulsions or fits
Nose, throat, eye or ear trouble
Diabetes
Skin conditions - medication
Hives, hay fever, asthma or allergy
Hear trouble, shortness of breath
Tropical diseases
Colour blindness
Stuttering
Wears corrective lens
Rheumatism or arthritis
Stomach, bowel or rectal problem
Hernia
Low back pain
Kidney or bladder trouble
Lung disease or chronic cough
Foot trouble
Motion or travel
Broken bones
Learning disabilities (i.e. dyslexia)
Hearing loss or impairment
Bet wetting
Menstrual problems producing disability
If you have checked "YES" to any of the above conditions, please give any additional information you feel is pertinent.
Describe any illnesses, injuries or disabilities not previously listed.
Describe any allergies, reactions/symptoms and treatments for the reactions (if EpiPen, can cadet administer him/herself?)
List any operation in the last 5 years.
Describe any dietary restrictions.
From day to day on extended activities, a cadet may need the following NON-PRESCRIPTION MEDICATION given to them by our Medical Officer. Please indicate which of the following medications we may administer. *
Administer child dose
Administer adult dose
Do not administer
PAIN - Tylenol (acetaminophen)
PAIN - Ibuprofen
UPSET STOMACH - Gravol
UPSET STOMACH - Pepto Bismol
UPSET STOMACH - Tums
SORE THROATS - Lozenges
SINUS CONGESTION - Allegra
SINUS CONGESTION - Benadryl
SINUS CONGESTION - Claritin
RASH OR INSECT BITES - Calamine lotion
RASH OR INSECT BITES - Afterbite
RASH OR INSECT BITES - Polysorin
OTHER MEDICATION SUPPLIED BY PARENT/ GUARDIAN
Name of medication #1
Amount taken, how often (everyday, once a week, only when necessary), taken with or without food and times taken (right when woken up, breakfast, lunch, supper, just before bed, when necessary)
Additional special instructions
Name of medication #2
Amount taken, how often (everyday, once a week, only when necessary), taken with or without food and times taken (right when woken up, breakfast, lunch, supper, just before bed, when necessary)
Additional special instructions
As the parent/guardian, I certify that the medical information is complete, accurate and valid to the best of my knowledge. I acknowledge that I am required to notify the cadet corps commanding officer immediately of any changes to the cadet's medical condition. *
Required
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