Athlete Medical Profile - Toronto Harriers

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 *

First

Last

Birth Date *

I identify as

Female
Male
Prefer not to say

Optional

Emergency Contact Details

Name *

Relationship

Phone Number *

Medical History

Current Medical Problems

Sports Injuries

Regular Medications

Allergies

Past Medical History

Signature

To the best of my knowledge all information provided above is correct. *