This form is for athletes who have already completed their Competitive Membership with Muaythai Canada, but need to submit or update their medical information. Annual Medical Declarations and blood work are only valid for 12 months from the date shown on the completed form.The athlete is a member of a club located in...*(Please Select)ABBCMBNBNLNTNSNUONPEQCSKYTOutside CanadaI am...*(Please Select)An athlete submitting my own medical documentsA parent/guardian submitting on behalf of my childA coach/administrator submitting on behalf of an athleteAthletes from Ontario Clubs must upload their medicals to the Muaythai Ontario Medical Form.SUBMITTER'S INFORMATIONYour Name* First Last Your Email* Enter Email Confirm Email ATHLETE INFORMATIONAthlete Legal Name* First Last Athlete Email* Enter Email Confirm Email Athlete's Club Affiliation*Athlete Age (Years)*Please enter a number greater than or equal to 0.Athletes age 15 an younger are not required to submit laboratory blood tests in order to participate in competition. When an athlete has reached 16 years of age HIV, Hepatitis B Surface Antigen, and Hepatitis C Antibody screening blood tests are required for judged full contact competition.COACH INFORMATIONCoach Name* First Last Coach Email* Enter Email Confirm Email Send a copy of the uploaded medical documents to my coachMedical documents are personal, private information and do not need to be submitted to anyone other than Muaythai Canada for approval.YesNoMedical Release Signature*By signing this form I authorize Muaythai Canada to release confidential health information about me, by releasing a copy of my medical records to the coach email address completed above.MEDICAL DOCUMENTS TO UPLOADI understand that for competition in Alberta I am required to bring a physical copy of my medical information to each event.* Yes Please select the medical documents that you will be uploading* Annual Medical Declaration Laboratory Blood Tests Clearance for Returning to Competition After Injury ANNUAL MEDICAL DECLARATION UPLOADUpload the Annual Medical Declaration here*All athletes participating in full contact competition must have a completed Annual Medical Declaration that has been completed no more than 12 months prior to the competition date. Both pages must be uploaded at the same time for a medical to be processed. File types: .jpg, .jpeg, .png, .pdf Maximum 20 MB. Drop files here or Accepted file types: jpg, jpeg, png, pdf. LAB TEST UPLOADUpload the scans of the completed HIV, HEP B, and HEP C tests here*All athletes age 16 years and older participating in full contact competition must have HIV, Hepatitis B Surface Antigen, and Hepatitis C Antibody screening blood tests that have been completed no more than 12 months prior to the competition date. All tests must be uploaded at the same time to be processed; individually uploaded tests will not be recorded. File types: .jpg, .jpeg, .png, .pdf Maximum 20 MB. Drop files here or Accepted file types: jpg, jpeg, png, pdf. CLEARANCE FOR RETURNING TO COMPETITION AFTER AN INJURYUpload the scans of the completed medical clearance letter*The medical clearance letter must be completed by a medical doctor. In the event that an athlete was on a medical suspension, the athlete must complete the duration of the suspension even if the medical clearance letter is completed in advance. File types: .jpg, .jpeg, .png, .pdf Maximum 20 MB. Drop files here or Accepted file types: jpg, jpeg, png, pdf. DOCUMENT PROCESSING TIMESDo you have an upcoming competition and require your medical documents processed by a specific date?*Standard processing time is 5-10 business daysYesNoWhat date do you need your documents processed by?* Date Format: DD slash MM slash YYYY Unfortunately we are not able to process your membership by the desired date. All information submitted to MTC required at least 1 business day to process. Please select a different date to continue. Refer to the image below for the document processing schedule: "OK" - Documents are processed without a rush fee "RUSH" - Only documents with a rush fee are processed "NOT PROCESSED" - Documents are not processed on these days, even with rush fees "EVENT DAY" - The day of the competitionIt Looks Like You Require Rush Processing In order to process your documents by the desired date, a rush processing fee is required. Rush information processing is required when submitting information 2 to 5 business days prior to an event an you are participating in. Refer to the image below for the document processing schedule: "OK" - Documents are processed without a rush fee "RUSH" - Only documents with a rush fee are processed "NOT PROCESSED" - Documents are not processed on these days, even with rush fees "EVENT DAY" - The day of the competition THERE ARE NO EXTENSIONS: If you rush incorrect or incomplete information there is no guarantee that it will be processed in time, and no deadline extensions will be provided. Ensure all submitted information is correct and complete; no refunds will be provided. Do you want to rush your documents to be processed within 2-5 business days?*Yes, rush my documents ($30)No, do not rush my documents ($0)Payment InformationYou selected to pay for a rush fee. Click SUBMIT and you will be redirected to a 'Rush Information Processing' page to complete your rush payment. If you do not complete the Rush Information Processing page after this, your information will not be rushed and processed within 5-10 business days.Rush Information Processing Fee Price: CAD$ 30.00 CAD Total CAD$ 0.00 CAD This iframe contains the logic required to handle Ajax powered Gravity Forms.