UPRISE FHC Winter Clinics

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Please complete the form below to register your athlete for the UPRISE Field Hockey Club Winter Field Hockey Clinics.

Upon completion of this form $165 per clinic participation fee must be paid.

The fee can be paid through Venmo to @DHeilig or cash or check payable to Danyle Heilig can be mailed to PO Box 122 Moorestown, NJ 08057.

Upon receipt, you will receive an email confirming your participation in the program.

Players Last Name *

Players First Name *

Players Grade *

Clinic Choice - Monday's, 5-6 pm

Clinic One - Grades 4-8, Nov. 15, 22, 29, Dec. 6 and 13

Clinic Two - Grades 4-8, Dec. 20, Jan. 3, 10, 17, and 24

Players Date of Birth *

YYYY

Email Address *

Emergency Contact and Phone Number *

My name (signature) below confirms that I agree to pay the participation costs in full without exception. *

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