Whitman-Hanson Field Hockey Clinic 2024

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Please complete the following form. On the first day of clinic, please bring a check for 100 dollars made out to Whitman-Hanson Field Hockey. Thank you!

Email *

First and Last Name of participant *

Grade participant is entering in the Fall of 2023 *

Address of participant *

Parent/Guardian of participant *

Emergency contact information: Cell Phone Number *

T-Shirt Size (Unisex Adult) *

XXL

My Child has the following allergies... *

My child has the following medical condition that may require immediate attention (911) at school sponsored or activities practice/events that occur outside of the regular school day. * *

Insurance Type and Number

I give permission for my son/daughter to participate in the WH Athletic Clinic. The school nurse may not be present during before, after school, or extra curricular programs . I agree to hold Whitman-Hanson, Bob Rodgers, all coaches, clinic counselors, officials, trainers and agents free from any liability whatsoever in the event of any type of injury or contraction of Covid 19; I also certify that my son/daughter has been through a physical examination within the last 13 months and that he/she is healthy and able to participate in the clinic. I also give my permission for the program to seek medical attention for my son/daughter in the event of an injury, but again will not hold the camp, its coaches, Whitman-Hanson Regional School District or its agents liable for said medical care or lack there of. I am aware that attending this program could put family members at risk in terms of the transmission of Covid 19. I affirm that I understand these risks and will not hold Whitman-Hanson Regional School District, its employees, its agents or any other party liable for any issues that may arise as a result of attending this program. *

Date *

YYYY

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