Finesse Field Hockey Summer Clinic 2019
 911656
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Player Name (first and last) *
Player Grade as of Sept. 2019 *
Street Address *
Town *
Parent Name *
Parent Phone Number *
Parent Email *
Emergency Contact Name *
Emergency Contact Number *
Insurance Carrier *
Insurance Policy Number *
Allergies
Waiver: I, the parent or legal guardian of the participant listed above, do hereby consent to his or her participation in the Finesse Field Hockey Summer Clinic 2019 and acknowledge that he or she is covered by the insurance policy described above. The registered player is fit to participate in the Finesse Field Hockey Summer Clinic 2019. In the event of an emergency, if a parent or guardian cannot be reached, I hereby authorize the director or staff to act for me according to their best judgment. I waive, release, and forever discharge Finesse Field Hockey, its directors, staff and host facilities, Hingham High School, from any and all liability, claim, loss, rights of action, present or future, anticipated or unanticipated, resulting from or arising out of or in incident to participation in this clinic. I hereby waive and release Finesse Field Hockey from any injury or illness incurred while at the clinic resulting from any cause. Please type name to signify acceptance of waiver. *
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