UNITED FIELD HOCKEY CLUB 2021 SPRING FH FITNESS REGISTRATION
MARCH 2021
AGE DIVISION Information Players Must be YOUNGER than the year of the Age Division as of 1/1/2020 *
Last Name *
First Name *
Date of Birth (Month/Day/Year) *
Age *
Graduation Year *
Family Contact Person *
Home # Name/Number *
Cell #1 Name/Number *
Cell #2 Name/Number (Contact #2) *
Cell #3: PLAYERS NAME/Number Write NONE if no Player Phone
email #1 *
email #2 Parent Contact #2 Name/email Write NONE if there is not a second email *
email #3: PLAYER'S EMAIL Player Name/email Write NONE if there is not a PLAYER'S email *
GRADE FALL 2020 *
School Attending Fall 2020 *
Sign & Date: Participant Agreement Release & Acknowledgment RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AND PARENTAL CONSENT AGREEMENT I hereby release and discharge the UNITED FIELD HOCKEY CLUB, its agents , employees, staff members, directors and officers from any claims, responsibilities or liabilities for injuries or harm incurred as a result of my participation and/or my child's participation as a player or spectator in programs and activities. I fully understand that these activities involve risks and dangers of serious bodily injury, sickness and disease (including communicable diseases), ("RISKS"), these Risks and dangers may be caused by my own actions or inactions, the actions or inactions of others participating in the activity, the condition in which the activity takes place or the negligence of the "RELEASEES" named below; there may be other risks and social and economic losses either not known to me or not readily foreseeable at this time; and I fully accept and assume all such risks and all responsibility for losses, costs and damages I incur as a result of my participation or that of the minor in the Activity. I authorize the United Field Hockey Club, its agents, employees, staff members, directors and officers to take whatever action is necessary, in their best judgment, in an emergency and I hereby release and discharge the United Field Hockey Club, its agents, employees, staff members, directors and officers from any responsibility or liability related thereto. I hereby grant the United Field Hockey CLub permission to use my name, picture or likeness and/or my child's name, picture or likeness in any printed media or any form of advertisement. I fully renounce any and all claims upon the United Field Hockey Club for reimbursement for use of this material. (Sign & Date) *
NOTE TO DIRECTOR - Send Message to Jill Dull or send email to Jill Dull: UnitedFieldHockeyClub@aol.com
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