Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.As a Run Club affiliated with Athletic Ontario we are required to obtain a Medical Profile of each of our athletes. The information provided in this form will be kept private and will only be shared with the coaches and used in the case of an unexpected emergency.At the very least we require an emergency contact name and number. Holding back relevant information may delay emergency services providing you with appropriate treatment.Athlete Name *FirstLastBirth Date *I identify asFemaleMalePrefer not to sayOptionalEmergency Contact DetailsName *RelationshipPhone Number *Medical HistoryCurrent Medical ProblemsSports InjuriesRegular MedicationsAllergiesPast Medical HistoryPlease check if you have had any of the following:EpilepsyDiabetesHeart ProblemsAsthmaMuscle or Joint InjuryPlease Provide Relevant DetailsSignatureTo the best of my knowledge all information provided above is correct. *Submit