REGISTRATION FORM & MEDICAL WAIVER · Strokeline Field Hockey, LLC Equipment Required: Field hockey...
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NAME: ________________________________________________________________ ADDRESS: _____________________________________________________________ ________________________________________________________________________ PHONE NUMBER: ( ) _______________________________________________ EMERGENCY PHONE: ( ) ___________________________________________ E-MAIL: _______________________________________________________________ NAME OF SCHOOL: _____________________________________________________ GRADE: _____________ AGE: _______________ D.O.B.: ________________ SHIRT SIZE: YOUTH ____________ ADULT ______________ REGISTRATION FORM & MEDICAL WAIVER 2016 Winter Youth Indoor Clinic I, the undersigned parent/guardian of the above named participant in the Strokeline Field Hockey Winter Youth Clinic, understand that by participating in this program, as with any athletic activity, runs the risk of injury. I understand that I am willing to assume those risks and I am responsible for the medical care of my child. I also understand that I am responsible for the dropping off and picking up of my child at the appropriate times, unless I have informed an administrator beforehand of any changes. I will not hold responsible or liable any coaches, volunteers, or Strokeline Field Hockey administrators for any injury loss or property sustained by the above named participant. Additionally, I hereby grant Strokeline Field Hockey permission to use my daughter’s likeness in a photograph or other digital reproduction in any and all of its publications, including website entries, without payment of any other consideration. _______________________________________________ Signature of Parent or Guardian Return this section with full payment payable ___________________________ to Strokeline Field Hockey, LLC. Date
Transcript of REGISTRATION FORM & MEDICAL WAIVER · Strokeline Field Hockey, LLC Equipment Required: Field hockey...
NAME: ________________________________________________________________
ADDRESS: _____________________________________________________________
________________________________________________________________________
PHONE NUMBER: ( ) _______________________________________________
EMERGENCY PHONE: ( ) ___________________________________________
E-MAIL: _______________________________________________________________
NAME OF SCHOOL: _____________________________________________________
GRADE: _____________ AGE: _______________ D.O.B.: ________________
SHIRT SIZE: YOUTH ____________ ADULT ______________
REGISTRATION FORM & MEDICAL WAIVER
2016Winter Youth Indoor Clinic
I, the undersigned parent/guardian of the above named participant in the Strokeline Field Hockey Winter Youth Clinic, understand that by participating in this program, as with any athletic activity, runs the risk of injury. I understand that I am willing to assume those risks and I am responsible for the medical care of my child. I also understand that I am responsible for the dropping off and picking up of my child at the appropriate times, unless I have informed an administrator beforehand of any changes. I will not hold responsible or liable any coaches, volunteers, or Strokeline Field Hockey administrators for any injury loss or property sustained by the above named participant. Additionally, I hereby grant Strokeline Field Hockey permission to use my daughter’s likeness in a photograph or other digital reproduction in any and all of its publications, including website entries, without payment of any other consideration.
_______________________________________________Signature of Parent or Guardian
Return this section with full payment payable___________________________ to Strokeline Field Hockey, LLC.Date
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Mail Registration:
Mail completed back page registration sheet along with check to: Strokeline Field Hockey, LLC 923 Pennsylvania Avenue Union, NJ 07083Deadline: January 1st, 2016
Presents Winter Indoor Youth Clinic at the Sports Domain Academy Clifton! We offer 8 weeks of skill instruction and competition for Middle School age players, grades 6th - 8th. Small coach to player ratio. Space is limited so sign up soon!
WHERE:
The Sports Domain Academy Clifton1075 US-46, Clifton, NJ 07013
WHEN:
Sunday Evenings; 5:30 - 6:30 p.m.January 3, 2016 - February 21, 2016
WHO:
6th, 7th, & 8th gradersSessions will include instructional drills, small games, and full field scrimmages!
We are ONLY accepting a limited number of players, so ACT FAST! First come, first serve!
Strokeline Field Hockey LLC
COST:
$200.00*Sibling discount - 10% off 2nd childThis cost includes a $50.00 non-refundable registration fee.
*Make checks payable to Strokeline Field Hockey, LLC
Equipment Required:
Field hockey stick, goggles, shin-guards, mouthguard, and sneakers/turf shoes. Goalies are encouraged to register and must provide their own equipment.
Our Philosophy:
“Our goal is to create a fun and safe environment where young female athletes can develop new skills and a love for the game of field hockey, while experiencing the confidence that success in sports can offer.” That’s Strokeline Field Hockey! Mary Pat Mercuro Injoo Han King Head Field Hockey Coach Head Field Hockey Coach Montclair High School Montclair Kimberley Academy
You can now visit us at our website at
www.strokelinefieldhockey.com!
Or email us questions at [email protected]
