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Schedule
Contribute
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NEW ATHLETE REGISTRATION
Participant/ Athlete Background
Athlete Name
*
First Name
Last Name
I (athlete) prefer to be called:
Date of Birth
*
MM
DD
YYYY
Athlete Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Athlete Phone
*
(###)
###
####
Athlete Email
Parent/ Substitute Decision Maker Name
*
First Name
Last Name
Parent/ Substitute Decision Maker Address (If different from above)
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Parent/ Substitute Decision Maker Phone (If different from above)
*
(###)
###
####
Parent/ Substitute Decision Maker Email
*
Secondary or Other Parent/ Substitute Decision Maker Name
First Name
Last Name
Secondary or Other Parent/ Substitute Decision Maker Address (If different from above)
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Secondary or Other Parent/ Substitute Decision Maker Phone (If different from above)
(###)
###
####
Secondary or Other Parent/ Substitute Decision Maker Email (If different from above)
Medical Background
Any information provided in the medical and functional sections listed below will be treated with the strictest confidentiality. Information will not be passed beyond the directors, management team, and coaches, without permission from the parent(s) or guardian(s). We encourage all participants to have an active health care plan, including regular physical examinations. Guelph Giants Hockey will not assume any financial or legal responsibility for the health care of the athlete.
Primary Diagnosis
*
Secondary Diagnosis
*
For participants with Down Syndrome, please indicate test results for Atlanto-axial dislocation below:
Please note that you will have to provide proof of test results if requested by the Guelph Giants.
Positive
Negative
How does the diagnosis or diagnoses affect the athlete?
Physically
*
Cognitively
*
Socially
*
List any medical concerns (E.G. Seizures, respiratory, medications, communicable diseases, etc.)
*
List any allergies (E.g. Medication related, insects, food, environmental, etc.)
*
List any significant health events that could affect participation (E.g. Surgeries, procedures, or injuries)
*
Functional Overview
What equipment does the athlete utilize to perform activities of daily living? (E.g. Wheelchairs, braces, etc.)
*
Describe the athlete's behaviour in terms of activity level, attention span, and impulsiveness
*
Please identify any known triggers that may initiate negative behaviour
*
Please indicate any strategies/ techniques that you find useful in managing the athlete's behaviour
*
Hockey Background
Program choice
*
Which program are you interested in?
Fundamentals
Junior Team
Intermediate Team
Has the athlete ever skated or been involved in hockey before?
*
Yes
No
If Yes, did you consider the experience successful?
*
Successful
Not Successful
Partially Successful
Why or why not?
Do you have any concerns with the athlete being involved with the Guelph Giants hockey program?
*
What are the goals and expectations of the program for the athlete?
*
As a volunteer organization, we rely on you to do what we do. Would you be interested in volunteering to be a part of the Guelph Giants? Please identify the capacity within the team(s) you feel you would contribute most. We require people to help with fundraising and social events, for instance.
Please answer the following questions on a scale from 1-5
1 being dependent or very hard, and 5 being independent or very easy.
Level of Independence:
Mobility
*
1
2
3
4
5
Transfer (E.g. Floor to chair, etc.)
*
1
2
3
4
5
Ability of the athlete to communicate with new people:
In General
*
1
2
3
4
5
To get attention of others/ ask for help
*
1
2
3
4
5
To communicate basic needs (E.g. Personal Care)
*
1
2
3
4
5
Ability to learn:
A new recreational activity
*
1
2
3
4
5
Registration Fee
The registration fee to participate in the Guelph Giants hockey program is $325.00 per athlete. The fee largely covers ice-time, insurance, and other incidental costs associated with the Guelph Giants hockey club. The Guelph Giants do a number of fundraising events to provide for our athletes and it is expected that you will contribute to these efforts. Please make all cheques payable to 'Guelph Giants Hockey.'
Qualified Disclaimer
Parents or Guardians for participants less than 18 years of age are asked to carefully read and acknowledge the following information. The text "You" pertains reference to both participant, parent/guardian, or substitute decision makers recognizing the statement presented. This page must be signed prior to participation in the Guelph Giants Hockey Program. - You (both) agree that Guelph Giants Hockey is not responsible for any bodily injury, loss or damage to personal property suffered by the participant before, during or after the program. - You (both) agree that in the event of emergency medical attention or emergency evacuation, you will not hold Guelph Giants Hockey responsible for any costs arising out of any emergency situation. - You (both) agree that intentional participant behavior that puts them or others at physical or emotional risk will result in immediate dismissal from the program at the discretion of the Guelph Giants directors responsible for the safety of the team. - You (both) agree that expenses incurred because of program dismissal will be the responsibility of the participant, parent, or guardian. - The safety of each individual is of the utmost importance to us and all the necessary precautions are taken prior to and during the program. Guelph Giants Hockey reserves the right to alter a program at any time without compensation of participant, parent, or guardian. - You (both) agree that any hockey equipment issued to an athlete that is to be used for the hockey program must be returned upon request or at the end of the season. If equipment is misplaced or lost, the participant, parent or guardian will reimburse the Guelph Giants Hockey Club for the full cost of the equipment. The Guelph Giants Special Hockey Foundation reserves the right to request further documentation to be presented by you.
Athlete Membership
Each athlete is granted one membership as an "Athlete Member" by signing the registration form. This status is available to those persons who are interested in furthering the objectives of the Guelph Giants hockey program or a representative of an athlete. A representative of an athlete may be designated upon admission of an Athlete Member. There shall only be one representative per athlete. Thank you for taking the time to provide us more information so that we can create a better experience for the athlete. Sincerely, Ken Keesmaat Board President On behalf of The Guelph Giants Special Hockey Foundation Board of Directors
BY CHECKING BELOW, YOU ACKNOWLEDGE THAT THE GUELPH GIANTS DO A NUMBER OF FUNDRAISING EVENTS TO PROVIDE OUR ATHLETES THE BEST EXPERIENCE POSSIBLE. THIS MEANS THAT ALL ATHLETES ARE EXPECTED TO PARTICIPATE TO ENSURE EQUITABLE TREATMENT AMONG ALL ATHLETES AND AVOID ATHLETES RECEIVING BENEFITS THEY HAVE NOT CONTRIBUTED TO FAIRLY. YOU ALSO AGREE THAT THE HEALTH HISTORY RECORD IS CORRECT, AS FAR AS YOU KNOW, AND THE ATHLETE DESCRIBED HAS PERMISSION, FROM BOTH PARENT/GUARDIAN AND PHYSICIAN, TO ENGAGE IN ALL HOCKEY RELATED ACTIVITIES.
*
We (Participant/ Athlete, Parent/Guardian and/or Substitute Decision Maker) have read, understood, and completed all sections of this registration form.
Thank you. You will be contacted shortly.
