UNITED FIELD HOCKEY CLUB                                                                                                                                                                                           SPRING 2021                                                                                                               - Field Player & Goal Keeper REGISTRATION                                                                                                                                                                                                                                                                                                                                                                                                                  
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AGE DIVISION Information                                                                                                                                                                                                 Players Must be YOUNGER than the year of the Age Division as of 1/1/2021                                                                                                                   *
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 *
Street Address *
City *
State *
Zip *
Are you a current member of USA Field Hockey?               *
Are you a Goal Keeper? *
HELP!!!   Please recommend a GK to play with our Team; Include contact name, phone # and email
FH Club History:  Name of Current FH Club
UNITED FH Club History:  Name of Current UNITED FHC Club Team
FH Club History:  Name of Former FH Club
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 AGREEMENTI 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 child's and/or my name, picture or likeness in any printed media or any form of advertisement. I fully renounce all claims upon the United Field Hockey Club for reimbursement for use of this material.                                                                                         (Sign & Date) * * *
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