Registration Please create an account by entering your e-mail and choosing a password. User E-mail * Choose a password * Why register to Judo Québec Judo Québec is the only sports federation recognized by the provincial government to see to the development and a safe practice of the activity of judo. Judo Québec’s rules and regulations demand mandatory insurance coverage by everyone practicing judo. To that end Judo Québec requires, through the participant’s membership to the Federation, an insurance policy covering risk and injuries that can occur while practicing judo. This membership is also mandatory to participate in tournaments and grade recognition. This membership is included in the registration fee to Club de judo Hibagon. If your membership is already paid at time of registration to the club a refund will be issued after confirmation of the participant’s membership to Judo Québec. How many children would you like to register? * 123 Guardian First Name if participant is a minor * Guardian Last Name if participant is a minor * Child First Name * Second Child First Name Third Child First Name Child Last Name * Second Child Last Name Third Child Last Name Address * City * Postal Code * Primary Phone * Alternate phone Secondary E-mail Status in Canada * Please choose oneRefugeePermanent residentCanadian citizen Course chosen * Parent-enfant U5 (born 2019 or after) U8 (born 2016-18) U10 (born 2014-15) U12 - U14 - U16 (born 2008-12) Self defense classes for women of all ages Course chosen for second child Parent-enfant U5 (born 2019 or after) U8 (born 2016-18) U10 (born 2014-15) U12 - U14 - U16 (born 2008-12) Self defense classes for women of all ages Course chosen for third child Parent-enfant U5 (born 2019 or after) U8 (born 2016-18) U10 (born 2014-15) U12 - U14 - U16 (born 2008-12) Self defense classes for women of all ages Photography Authorization Please read carefully I, the undersigned, grant authorization to Club de Judo Hibagon to photograph, film, and produce images of my child(ren). I renounce all rights to remuneration and claims against Club de Judo Hibagon by signing below. Signature for photography (Please type your full name) Date Former club (if applicable) Second Child Former club (if applicable) Third Child Former club (if applicable) Judo Canada/Judo Québec passport number (if applicable) Second Child Judo Canada/Judo Québec passport number (if applicable) Third Child Judo Canada/Judo Québec passport number (if applicable) Please read carefully I, the undersigned, declare that the details provided here are accurate. I accept becoming a member of Club de Judo Hibagon and all the risks inherent to the practice of Judo. I will not hold responsible the professors or other members for any accidents or lost property inside the club or any location of activities. Participant or parent signature (Please type full name) * Participant Medical Sheet Important Notice Judo Québec’s guidelines and regulations stipulate that all registration to the activity of judo requires for the participant to provide a medical sheet for insurance purposes. Gender * M F Second Child Gender M F Third Child Gender M F Date of Birth * Second Child Date of Birth Third Child Date of Birth Insurance number * Second Child Insurance number Third Child insurance number Insurance Expiration date * Second Child Insurance Expiration date Third Child Insurance Expiration date Medication * Yes No Second Child Medication Yes No Third Child Medication Yes No Medication - if yes, please specify: Allergy * Yes No Second Child Allergy Yes No Third Child Allergy Yes No Allergy - if yes, please specify: Blood type A+ A- B+ B- AB+ AB- O+ O- Second Child Blood type A+ A- B+ B- AB+ AB- O+ O- Third Child Blood type A+ A- B+ B- AB+ AB- O+ O- Concussion * Yes No Second Child Concussion Yes No Third Child Concussion Yes No Concussion: if yes, specify date Second Child Concussion: if yes, specify date Third Child Concussion: if yes, specify date Concussion: if yes, specify severity Second Child Concussion: if yes, specify severity Third Child Concussion: if yes, specify severity Have you recently felt pains or strange feelings after knocking your head? * Yes No If yes, please explain: Second Child: Have you recently felt pains or strange feelings after knocking your head? Yes No Second Child - If yes, please explain: Third Child: Have you recently felt pains or strange feelings after knocking your head? Yes No Third Child - If yes, please explain: Known Medical Problems Head injury * Yes No Spasms * Yes No Heart problems * Yes No Blood problems * Yes No Hypertension * Yes No Hot Flashes/dehydration * Yes No Asthma * Yes No Diabetes * Yes No Menstrual problems * Yes No Abdominal problems * Yes No If yes to any known problems, please specify: Significant injuries or treatments in last 12 months: Second Child Head injury Yes No Second Child Spasms Yes No Second Child Heart problems Yes No Second Child Blood problems Yes No Second Child Hypertension Yes No Second Child Hot Flashes/dehydration Yes No Second Child Asthma Yes No Second Child Diabetes Yes No Second Child Menstrual problems Yes No Second Child Abdominal problems Yes No Second Child - If yes to any known problems, please specify: Second Child - Significant injuries or treatments in last 12 months: Third Child Head injury Yes No Third Child Spasms Yes No Third Child Heart problems Yes No Third Child Blood problems Yes No Third Child Hypertension Yes No Third Child Hot Flashes/dehydration Yes No Third Child Asthma Yes No Third Child Diabetes Yes No Third Child Menstrual problems Yes No Third Child Abdominal problems Yes No Third Child - If yes to any known problems, please specify: Third Child - Significant injuries or treatments in last 12 months: Emergency Contacts Contact first name * Contact last name * Relationship * Contact home phone * Contact work phone Contact mobile phone * Contact alternate phone Contact Address * Please read carefully and sign below: If the athlete is a minor (younger than 18 years old), the parent/guardian must sign below. By signing (typing your name below), you certify that the details provided in this document are truthful and accurate. Date of signature for the medical sheet * Signature for the medical sheet (Please type your full name) * Consent for disclosure and sharing of personal information Please read carefully I, the undersigned parent or guardian, of the following minor(s) consent to the supervisor(s) of Club de Judo Hibagon communicating the following personal information of my child(ren): First and last name, Date of birth, Address, Gender, as well as my following information: Telephone number, E-mail address, to the provincial and national judo federations, that is, Judo Québec and Judo Canada.. This information serves to identify my children within the federations which will be able to communicate with me for all activities for which my children are enrolled and for all safety measures that concern them. Only the employees of these federations will have access to this information and they will not share it with any other organizations without my consent. At all times, I may withdraw my consent to the disclosure and sharing of my information. Signature for consent of the person concerned (Please type the full name) * Date of the signature for consent of the person concerned * Register