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General Info.
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Registration Info.
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Medical Information
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Waiver Form
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Entry Form
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Fitness Walk
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Line-Dance Registration
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Checklist Form
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Medical Information Form
In order to provide appropriate health care for each participant in the Games, it is important that the Sports
Medical Personnel be aware of any special problems or needs of each athlete.
In order to participate, you must complete the form below.
This information will be made available to the
Sports Medical Staff.
NAME __________________________________________________________________
STREET _________________________________________________________________
CITY _________________________________________________STATE ____________
ZIP _______________________ PHONE NUMBER ____________________________
1. List any special medical problems. (Respiratory problem, diabetes, etc.)
__________________________________________________________________________
2. List any special musculoskeletal problems. (Joint instability,
etc.)
___________________________________________________________________________
3. List any allegeries.___________________________________________________________
___________________________________________________________________________
4. List any medications that you are on.___________________________________________
___________________________________________________________________________
5. List any additional information that would be useful to the Sports Medical Staff.
___________________________________________________________________________
6. I am registered for the following events :
___________________________________________________________________________
___________________________________________________________________________
7. In the event of an emergency, please notify :
NAME ________________________________________________________________________
STREET ______________________________________________________________________
CITY ______________________________________STATE __________ZIP ______________
PHONE NUMBER (Area Code) ____________________________________
Signature _____________________________________________Date ____________________
If you have any questions regarding this form,
please call (413) 748-3812.
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