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Search for:
Donate
Contact Us
Get Involved
Careers
Volunteer Opportunities
Internships
FR
Search for:
Donate
Contact Us
Get Involved
Careers
Volunteer Opportunities
Internships
FR
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CSCM Athlete Intake
CSCM Athlete Intake
2023 CSCM Athlete Intake
Are you 18 years or older?
*
Yes, I'm 18 or Older
No, I'm 17 or Younger
Parent / Guardian Information
Name of Parent/Guardian
*
Email of Parent/Guardian
*
Phone Number of Parent/Guardian
*
General Information
First Name
*
Last Name
*
Date of Birth
*
Sex Assigned At Birth
Male
Female
Prefer Not To Say
Home Province
*
Primary Address
*
Primary Address
Primary Address
Primary Address
City
City
State/Province
State/Province
Zip/Postal
Zip/Postal
Country
Afghanistan
Aland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei
Bulgaria
Burkina Faso
Burundi
Côte d'Ivoire
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Country
Primary Phone Number
*
Primary Email
*
Are you a Manitoba resident?
*
Yes
No
Where are you visiting from?
*
Ex. Calgary, Alberta or Canadian Sport Centre Calgary
Manitoba Health Registration Number
*
6-Digit Number
Personal Health I.D. Number
*
9-Digit Number
Emergency Contact Information
Emergency Contact Name
*
Relation
*
Emergency Contact Phone Number
*
Sport Information
Sport
*
Ex. Soccer, Taekwondo, Diving
Are you currently involved in a Training Group or Integrated Support Team in partnership with the Canadian Sport Centre Manitoba?
*
No
Yes
Ex. Diving Training Group, Rowing Manitoba Training Group, Etc.
Which training group are you involved in?
*
Diving
Triathlon Manitoba
Rowing Manitoba
Speedskating
Carding Status
*
Senior International Card (SR1/SR2)
Senior National Card (SR)
Senior Probationary Card (C1)
Development Card (D)
D-Regional (D-Reg)
National Development Team Athlete (Not Carded)
Currently Not Carded or On National Development Team
At what level do you currently compete in?
*
International Level
National Level
Provincial Level
Local Level
Current Organization/Team
*
Current National Rank
*
If unsure, please select 0.
Current World Rank
*
If unsure, please select 0.
Primary Coach Name
*
Primary Coach Phone Number
*
Primary Coach Email
*
Game Plan
Do you have any non-sport plans or goals for the future?
*
No
Yes
Plans for Career, Education, Personal Development, Etc.
Tell us about your plans and/or goals.
*
Would you be like to be invited to Game Plan Online Sessions & other COPSIN workshops??
*
Yes
No
Select the areas that you would be interested in learning more?
Career
Community
Education
Skill Development
Health
Employment
Are You Currently Employed?
*
No
Yes
Current Employer:
*
Position:
*
Number of hours worked per week:
*
Describe your typical week (including training schdule):
*
Nutrition
Have you worked with a Sport Dietitian / Nutritionist previously?
*
No
Yes
Did you work with a Sport Dietitian / Nutritionist in a group setting or individually?
*
Individual
Group
Do you have any specific goals or issues that you would like to discuss with a CSCM Sport Dietitian?
*
No
Yes
Please explain your goals and/ or issues you would like to discuss?
*
Which of the following nutrition-related goals are you interested in working on?
*
Improve Training Fitness
Decrease Fatigue
Enhance Recovery
Improve Competition Fuelling
Muscle Gain
Fat Loss
Optimizing Hydration
Other
What are the other nutrition-related goals are you interested in?
*
Please check the following that apply to you
Nausea
Diarrhea
Low Fat Diet
Vegan/Vegetarian
Bloating
Gluten-Free
High Protein Diet
Dairy Free
Sleep Issues
Cramping
Low Iron
Extreme Fatigue
Mood Disturbances
Anxiety
Live Alone
Stress
Constipation
Have you intentionally or unintentionally had a change in your weight over the past 2 - 3 months?
Increased
Decreased
No, I have not (Stable)
Unsure
Mental Health & Wellness
Have you worked with a Sport Psychologist in the past?
*
No
Yes
What did you find most helpful speaking with a Sport Psychologist?
*
What did you find least helpful speaking with a Sport Psychologist?
*
Do you have interest working with a Sport Psychologist at CSCM?
*
No
Yes
Tell Us Why?
*
Are there any areas of health and wellness impacting your mental outlook, emotions and/or performance?
No
Yes
If possible, please describe as best as you can.
What are some of your mental strengths?
*
What are some of the mental skills you would like to improve on?
In general, what do you enjoy the most about participating/competing in sport?
*
How often do you feel Nervous?
1
2
3
4
5
(1= Never; 3=Sometimes; 5=Always)
How often do you feel Hopeless?
1
2
3
4
5
(1= Never; 3=Sometimes; 5=Always)
How often do you feel Restless or Fidgety?
1
2
3
4
5
(1= Never; 3=Sometimes; 5=Always)
How often do you feel Worthless?
1
2
3
4
5
(1= Never; 3=Sometimes; 5=Always)
How often do you feel Depressed
1
2
3
4
5
(1= Never; 3=Sometimes; 5=Always)
Is there any additional information you believe would be helpful for the sport psychologist to know?
Example: Challenging life events, prior experience with counselling , family history of mental illness, difficult experience in sport, etc
Physical Preparation & Training History
Have you done any formal training?
No
Yes
Example (Weights, Dry-Land, Etc.)
Where and with whom, did you complete your training?
*
Select all training methods you have done in the past:
*
Free Weights
Olympic Lifting
Sprint Training
Plyometrics
Change Of Direction
Agility / Quickness
Energy System Training (Aerobic, Anaerobic)
Yoga / Pilates / Barre
Cross Fit
Other
How many years have you been using these types of training?
*
Describe your last three weeks of training?
*
Frequency, Training Types, Time, Etc
Current Injury Status
Please list any current injuries we should be aware of.
Are you currently recovering from an injury?
No
Yes
Please describe your current injury.
*
Have you had any injuries and or illness in the past 6-12 months that have restricted your training for a week or longer?
No
Yes
What was your injury/illness and how long was your training load compromised for?
*
Injury History
Please list your past injuries.
Is there any past injuries CSCM should know about?
No
Yes
Date Of Injury
*
Description of injury & how it was managed/treated?
*
Add
Remove
Service Providers
Please list your primary service providers names and contact information below.
Do you have a Physician?
*
No
Yes
Name Of Physician
*
Dr. John Smith
Physician Phone Number
*
204-123-4567
Physician Email Address
*
john.smith@physician.com
Do you have a Physiotherapist / Athletic Therapist?
*
No
Yes
Name Of Physiotherapist / Athletic Therapist
*
Physiotherapist / Athletic Therapist Phone Number
*
Physiotherapist / Athletic Therapist Email Address
*
Do you have a Chiropractor?
*
No
Yes
Name of Chiropractor
*
Chiropractor Phone Number
*
Chiropractor Email
*
Do you regularly use the services of a chiropractor?
*
No
Yes
Do you have a Osteopath Provider?
*
No
Yes
Name of Osteopath Provider
*
Osteopath Provider Phone
*
Osteopath Provider Email
*
Do you have a Massage Therapist?
*
No
Yes
Name of Massage Therapist
*
Massage Therapist Phone
*
Massage Therapist Email
*
Do you regularly use the services of a Massage Therapist?
*
No
Yes
Do you have a Naturopathic Provider?
*
No
Yes
Name of Naturopathic Provider
*
Naturopathic Provider Phone
*
Naturopathic Provider Email
*
Tell Us More About Yourself
Applicants Short-Term Sports Goals
*
Applicants Long-Term Sports Goals
*
Why do you want to become a CSCM Athlete?
*
Do you have a bio hosted on the COC/CPC or your NSO/PSO website? If so, please link it here.
*
Note - this link may be shared as part of an online CSCM bio. If you have more than one bio link, please indicate which one you prefer we share.
Social Media
Please provide us with your social media information. Instagram, Twitter, Youtube, Facebook, LinkedIn, Etc
Platform
Username/Handle
Profile URL
I agree to allow CSCM to share this information.
*
Yes, you can share or post this.
No, please keep this private.
Add
Remove
Headshot / Photo
If you have one, please submit a recent headshot and/or action image. Please indicate whether you give CSCM permission to use these photos (including, but not limited to on the website, in promotional materials, on social media, etc). Please only submit images that you have the rights/permissions to share.
Headshot
Drop a file here or click to upload
Choose File
Maximum upload size: 5MB
Action Image
Drop a file here or click to upload
Choose File
Maximum upload size: 5MB
Please indicate whether you give CSCM permission to use these photos.
Yes, CSCM can use this image online and in print.
No, CSCM cannot use my images.
Additional Information
Tell us here!
Review & Submit
I Agree, all the information given in this application is complete and true.
*
I Agree
I Agree, The Canadian Sport Centre Manitoba is authorized to verify any information contained in this application.
*
I Agree
I Agree, to be contacted via Email, Text (SMS) , and other communication methods by the Canadian Sport Centre Manitoba.
*
I Agree
I Agree, the Canadian Sport Centre Manitoba is authorized to contact my coach in my respective sport.
*
I Agree
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