Get Canada Asn Medical Self-declaration

Completing the Canada ASN Medical Self-Declaration is a crucial step for individuals applying for a competition licence in karting. This comprehensive guide will help you understand each section of the form and provide clear instructions to ensure a smooth submission process.

Follow the steps to complete the medical self-declaration form.

1. Click the ‘Get Form’ button to obtain the Medical Self-Declaration form and open it in your browser.
2. Begin by providing your personal information. This includes your name, age, address, city, occupation, province, postal code, and date of birth. Ensure all information is printed in block letters for clarity.
3. Indicate if you wear glasses or contacts by selecting ‘Yes’ or ‘No’ from the given options.
4. Review the list of medical conditions presented. For each condition that applies to you, select ‘Yes’ or ‘No’. This section includes conditions like frequent headaches, unconsciousness, heart trouble, and any hospital admissions within the past year.
5. If applicable, indicate the date of your last tetanus shot.
6. Provide additional comments regarding any medical conditions that may affect your ability to compete. Be as detailed as necessary to clarify your situation.
7. Review the certification statement at the end of the form. By signing, you certify that the information provided is true and permit any hospital or physician to share relevant information with ASN Canada FIA.
8. Complete the signature section by signing the form and printing your name. If you are under the age of majority, ensure that a parent or guardian also signs the form, including their printed name and date.
9. Save your changes to the document. You may also choose to download, print, or share the completed form as required.

Complete your medical self-declaration form online today to ensure your eligibility for competition!