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Whitman-Hanson Field Hockey Clinic 2024
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!
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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) *
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 *
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