ࡱ> _a^[ f,bjbj 46ΐΐ~Q$ $ ggggg{{{8\${3KKKK Ta,$T "JEgggKK4XXgKgK ?Ks{/n07@#m@#??&@#get@#$ -:  Confirmation of Health and Fitness This Statement of Health & Fitness must be returned to Ivonne Shoucair at  HYPERLINK "mailto:Ivonne@diving.ca" Ivonne@diving.ca no later than . Just type answers in the grey boxes. Failure to return this form may result in you being withdrawn. Competition:  FORMTEXT       1. Diver s Name  FORMTEXT       2. Phone Numbers (diver)  FORMTEXT       (parent)  FORMTEXT       (coach)  FORMTEXT       3. I will  FORMCHECKBOX / will not  FORMCHECKBOX be attending the above-mentioned event. (Please check as appropriate). 4. I confirm that, to the best of my knowledge, I am in good health, physically fit and injury free. I am able to travel and take a full and active part in the camp/competition. Yes FORMCHECKBOX  / No FORMCHECKBOX  (Please check as appropriate). If No, please provide details below  FORMTEXT       5. If training has been affected for more than a 1  2 week period over the past 3 months please explain how it was affected and how you are doing now.  FORMTEXT       6. Reports have been sent to the Team Doctor. Yes FORMCHECKBOX  &')`pstijٳٍr\A\A)/hkLhX0J6CJOJQJ^JaJmH sH 4jhkLhX6CJOJQJU^JaJmH sH +hkLhX6CJOJQJ^JaJmH sH 4hkLhX56CJOJQJ\]^JaJmH sH .hkLhX6CJOJQJ]^JaJmH sH h9OJQJ^JmH sH  hXh6zOJQJ^JmH sH (hXhqCJOJQJ^JaJmH sH  hXhqOJQJ^JmH sH )jhXh9OJQJU^JmH sH '()( )   Z \ 0 wuuuu$a$gdAgdXTkd%6$$Ifl0$ t644 laytX $Ifgd9 $Ifgd6z $Ifgdq $$Ifa$gdX ' ( ) 8 9 C ϷhS="=4jhkLhA5CJOJQJU^JaJmH sH +hkLhA5CJOJQJ^JaJmH sH (hkLhqCJOJQJ^JaJmH sH 4hkLh956CJOJQJ\]^JaJmH sH 4hkLhX56CJOJQJ\]^JaJmH sH 1hkLhX6>*CJOJQJ]^JaJmH sH .hkLhX6CJOJQJ]^JaJmH sH +hkLhX6CJOJQJ^JaJmH sH 4jhkLhX6CJOJQJU^JaJmH sH  C D  2 4 H J L V X Z b ǧǑǑbǧQ9.hkLhA5CJOJQJ\^JaJmH sH  hkLh>CJOJQJ^JaJ:j6hkLhA5CJOJQJU^JaJmH sH  hkLhACJOJQJ^JaJ+hkLhA5CJOJQJ^JaJmH sH ?jhkLhA5CJOJPJQJU^JaJmHnHsH u4jhkLhA5CJOJQJU^JaJmH sH :j6hkLhA5CJOJQJU^JaJmH sH    " , . 2 ˬkL; hkLhACJOJQJ^JaJ=jU8hkLhA5CJOJQJU\^JaJmH sH =j7hkLhA5CJOJQJU\^JaJmH sH BjhkLhA5CJOJPJQJU\^JaJmHnHsH u=jm7hkLhA5CJOJQJU\^JaJmH sH .hkLhA5CJOJQJ\^JaJmH sH 7jhkLhA5CJOJQJU\^JaJmH sH 0 2   & ' K B3cw &#$$d%d&d'd+DU/NOPQgd>`gd> ^`gd9gd> 0^`0gd> 2 F H d f h ~   jN7j9hkLh>CJOJQJU^JaJmH sH .hkLh@f86CJOJQJ]^JaJmH sH .hkLh>6CJOJQJ]^JaJmH sH 7j=9hkLh>CJOJQJU^JaJmH sH 7j8hkLh>CJOJQJU^JaJmH sH 1jhkLh>CJOJQJU^JaJmH sH (hkLh>CJOJQJ^JaJmH sH   ' K L V W   ʵw_Bw-(hkLhjzlCJOJQJ^JaJmH sH 8jhkLh>CJOJPJQJU^JaJmHnHu/j:hkLh>CJOJQJU^JaJ hkLh>CJOJQJ^JaJ)jhkLh>CJOJQJU^JaJ.hkLh>6CJOJQJ]^JaJmH sH (hkLh>CJOJQJ^JaJmH sH 1jhkLh>CJOJQJU^JaJmH sH 7j%:hkLh>CJOJQJU^JaJmH sH @BDXZ\fhjln{fQ81jhkLh9CJOJQJU^JaJmH sH (hkLh4CJOJQJ^JaJmH sH (hkLhqCJOJQJ^JaJmH sH 8jhkLh>CJOJPJQJU^JaJmHnHu/j;hkLh>CJOJQJU^JaJ hkLh>CJOJQJ^JaJ)jhkLh>CJOJQJU^JaJ(hkLh>CJOJQJ^JaJmH sH (hkLh9CJOJQJ^JaJmH sH Bjln&&&&D)F)))****4+$@&gdq`gd9$a$gdqgdqgd>3bw &#$$d%d&d'd+DU/NOPQgd>&&&0&2&4&D&&&&&&''''ʵʵʵjUjU=U=.hkLhq5CJOJQJ\^JaJmH sH (hkLhqCJOJQJ^JaJmH sH (hkLh6zCJOJQJ^JaJmH sH .hkLh96CJOJQJ]^JaJmH sH 7j;hkLh9CJOJQJU^JaJmH sH U(hkLh9CJOJQJ^JaJmH sH 1jhkLh9CJOJQJU^JaJmH sH 7j;hkLh9CJOJQJU^JaJmH sH / No FORMCHECKBOX  (Please check as appropriate). Divers/Parents: If you/your diver become ill, injured or in any way unable to dive from the time you have signed this form until departure, you must notify the High Performance Director. If this is not done and you/your diver travel with the team, unable to compete at full fitness, you may be liable for all of your expenses relevant to this event. Diver s Signature ______________________ Date __________________________ For Divers Under 18 ONLY Signed ______________________________ Date: ______________________ Name  FORMTEXT       Relationship FORMTEXT       Parent FORMCHECKBOX  /Guardian FORMCHECKBOX  (please check)     This Form Must be Fully Completed or it WILL BE RETURNED to you '''')))*b*d******軦u`Du7jm<hkLh4CJOJQJU^JaJmH sH (hkLh4CJOJQJ^JaJmH sH 1jhkLh4CJOJQJU^JaJmH sH .hkLhq5CJOJQJ\^JaJmH sH (hkLh6zCJOJQJ^JaJmH sH (hkLhqCJOJQJ^JaJmH sH .hkLhX5CJOJQJ\^JaJmH sH .hkLh45CJOJQJ\^JaJmH sH *****+++++&+(+2+4+B+D+`+b+d+~+++ȳȉmȳȉQȳȉ7jY=hkLh[Q<CJOJQJU^JaJmH sH 7j<hkLh4CJOJQJU^JaJmH sH (hkLh4CJOJQJ^JaJmH sH (hkLh6zCJOJQJ^JaJmH sH (hkLhqCJOJQJ^JaJmH sH 1jhkLh4CJOJQJU^JaJmH sH <jhkLh4CJOJPJQJU^JaJmHnHsH u+++++++++++++++Z,\,`,b,d,f,ʵjUQMh/h9(hXh9CJOJQJ^JaJmH sH (h9h9CJOJQJ^JaJmH sH hqjhqU(hkLh6zCJOJQJ^JaJmH sH (hkLh4CJOJQJ^JaJmH sH (hkLhqCJOJQJ^JaJmH sH 1jhkLh4CJOJQJU^JaJmH sH 7j=hkLh[Q<CJOJQJU^JaJmH sH 4++++++++++,,\,^,`,b,d,f,gd9$a$gd9gd9 ^`gdkL21h:pkL/ =!"#$% %6Ddssl\  C 8A DPC color 1inchRu5 5]HQ5DyFI5 5]HJFIFLEAD Technologies Inc. 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