The following information will be used by The Windsor Stars Baseball Club and Baseball Ontario for this year's rosters. The medical information below that will only be used by the Head Coach of each team and / or the designated team trainer and will not be distributed to anyone else.

Form

Player Information

Team

Player's First Name

Player's Last Name

Player's Number

Email

Phone

Date of Birth

Gender

M F

Address

Street Address

City

Country

Additional Parent Info

Parent 1 Name

Email & Phone noted above in Player Info

Parent 2 Name

Parent 2 Email

Parent 2 Phone

Medical Info

Emergency Contact Name

Emergency Contact Relationship to Player

Emergency Contact Phone

Epileptic

No Yes

Wears Dental Appliance

No Yes

Previous History of Concussions

No Yes

Asthma

No Yes

Trouble Breathing During Exercise

No Yes

Wears Glasses / Contact Lenses

No Yes

Diabetic

No Yes

Heart Condition

No Yes

Wears Medical Bracelet

No Yes

Allergies

No Yes

List all Allergies

Do Any Allergies Require an Epi-Pen

No Yes

Any Other Health Problems

No Yes

Details For Any Yes Answers

List all Medications

List Any Recent Injuries

Completion

Current Date

Name

Payment

Discount

Subtotal

Tax

Total USD

Thank you for your registration

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