Prospective Athlete Form

If you are interested in becoming a part of a Fanshawe Falcons Varsity team, this form MUST be fully completed prior to the tryout date.

* NOTICE: THIS ONLINE FORM IS CURRENTLY ONLY COMPATABLE IN INTERNET EXPLORER, CHROME OR FIREFOX.

PRESTOSPORTS IS WORKING ON SOLVING THE CURRENT ISSUE WITH SAFARI NOT WORKING.

Sport: *

What academic year are you trying out for the Falcons? *

2024-25 2025-26

Email address *

First name *

Last name *

Phone Number (###-###-####): *

Hometown Address: *

City and Province: *

Postal Code:

Date of Birth: *

Date Picker

Name of Parents/Guardians:

Are you an international student? *

Yes No

If yes, what is your home country?

Fanshawe Student #:

Program Choice:

Are you applying to residence?:

Yes No

Are you applying or registered in an apprenticeship program?: *

Yes No

Are you applying or registered in a collaborative program?: *

Yes No

Do you have a valid passport?: *

Yes No

Have you ever previously played any varsity sport for any University or College?: *

(in Canada or internationally)

Yes No

If yes, please indicate the school/ sport/ number of years played:

Have you ever previously played professionally? *

Yes No

If yes, who did you play for?

High School:

City:

Club Name:

Coach Name:

Coach Email:

Position:

(if applicable)

Height:

(if applicable)

Golf Handicap:

(if applicable)

Health Waiver & Questionnaire

Intense physical activity, such as Varsity sports, can aggravate certain health conditions. We are willing to try to work with you in managing your symptoms, if possible, but they need to be identified for us to do so. Your health and safety is our main concern and we appreciate your cooperation in completing this short questionnaire. All information provided will be available to the coaches and trainers, and will be used only to maintain a healthy and safe sports environment.

Please note that if you are successful in making a varsity team, you will be subject to a medical physical evaluation that comes at a cost.

Have you ever had a head injury? *

Yes No

If yes, when?

If yes, did it result in loss of consciousness?

If yes, do you have any lasting effects from this head injury? Please describe:

(e.g. persistent headaches, dizziness, seizures, etc.)

Have you had any other injuries in the past that have prevented you from sports or daily activities? *

(e.g. broken bones, serious strains/sprains, back injuries, etc.)

Yes No

If yes, please describe:

Do you have any medical conditions that are made worse by, or cause distress during exercise? *

(e.g. asthma, chest pains, muscle cramps, etc.)

Yes No

If yes, please describe:

NOTICE: The personal information on this form is collected under the authority of the Ministry of Colleges and Universities R.Sc. 1980 C272. The personal information will be used to record student participation in varsity and extramural sports, determine eligibility and academic performance, maintain OCAA and CCAA records, notify emergency contact, international travel (US Customs), plan athletic programs, determine administration for media promotion and marketing.

Pursuant to section 39 of the Freedom of Information and Protection of Privacy Act, I have read the above statement and I, the undersigned, herby authorize the disclosure of necessary information to the above mentioned parties.

CONSENT: I understand that participation in the Varsity Athletic Program involves certain risks and dangers which are inherent to sport while training or competing and include but are not limited to death, serious neck and spinal injuries, head or eye injuries, serious injuries to virtually all bones, joints, ligaments, muscles, tendons and other aspects of the muscular-skeletal system, and serious injuries or impairment to other aspects of my body, general health and well-being.

I recognize the risk inherent in the game and hereby release Fanshawe College of Applied Arts and Technology and the Fanshawe College Student Union, Officers, Servants and Agents (“Fanshawe College”), the Ontario College Athletic Association (OCAA) and the Canadian College Athletic Association (CCAA) from any liability whatsoever arising out of or in connection with any activity within the scope of the Varsity Athletic Program, including any liability due to the negligence or a breach of contract in the course of my participation or involvement in the Athletic Program.

I further acknowledge that I have read the above release and understand that I am relinquishing any and all rights that I, or any of my dependants, or my heirs, executors or administrators might have against Fanshawe College and the Fanshawe College Student Union, Officers, Servants and Agents, (“Fanshawe College”), the Ontario College Athletic Association (OCAA) and the Canadian College Athletic Association (CCAA) for any loss, damage, injury or expense suffered by me in connection with all activities associated with my participation in the Varsity Athletic Program.

In consideration of being permitted to compete in the Varsity Athletic Program, I hereby release and forever discharge from any claim and liabilities whatsoever without limitation I might have against Fanshawe College and the Fanshawe College Student Union, Officers, Servants and Agents (“Fanshawe College”), the Ontario College Athletic Association (OCAA) and the Canadian College Athletic Association (CCAA) in any of the activities I am involved in, and make this release on behalf of myself, and on behalf of my heirs executors, administrators and assignors.

I certify that the information provided above is complete and accurate.

I accept the responsibility that I am medically and physically fit to participate in tryouts and practices with Fanshawe Athletics.

I certify that the above information does not prevent me from safely participating in practices/tryouts with Fanshawe Athletics.

Signature of Consent: *

Signature of Parent/ Guardian if under 18:

* required field