Medical Intake for Tryout Form

There are errors with your form submission. Please review and submit again

MEDICAL CLEARANCE QUESTIONNAIRE

Individuals interested in trying out for an RDC Team must complete the medical clearance questionnaire prior to contacting our coaching staff. 

The personal information that you provide on this form is being collected under the authority of the Post-Secondary Learning Act and the Freedom of Information and Protection of Privacy Act of Alberta.  The information will be retained by the department in accordance with approved Information Management guidelines and/or may be stored on a third party system and will be protected in compliance with the provisions of the Freedom of Information and Protection of Privacy Act of Alberta.  If you have any questions about the collection and use of this personal information, please contact the Athletics Director, Red Deer College, 100 College Blvd, Box 5005, Red Deer, Alberta, T4N 5H5.  Telephone: 403.357.3669.

PERSONAL INFORMATION

MEDICAL INFORMATION

Please select the appropriate response.  You MUST provide details below if you answer “Yes” to any of the questions

EMERGENCY CONTACT INFORMATION

AGREEMENT

I agree to voluntarily tryout for an RDC athletics team. I understand that exercise carries risk and that I may experience muscle fatigue, shortness of breath, lightheadedness or symptoms of cardiovascular distress. I realize that I may voluntarily discontinue exercise at any time. The program supervisor also has the right to discontinue my participation at his/her discretion for any cause. I acknowledge that it is my responsibility to inform the supervisor of any symptoms of discomfort or pain that I may feel.


In consideration for my being allowed to tryout for an RDC Athletics team I waive all rights to sue or otherwise claim against Red Deer College, its employees or volunteers with respect to any and all losses which I may suffer as a result of injuries sustained while participating in the tryout activities.


I acknowledge that the information provided is true and I understand that failure to disclose may result in the loss of the opportunity to tryout for an RDC Athletic team.  I consent to the collection, use, storage and disclosure of my personal information in the manner stated above.

* required field