SKILLS CLINIC SPRING 2024
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PLAYER'S NAME *
SCHOOL/HOMESCHOOLING ATTENDING *
GRADE LEVEL *
PARENT NAME *
PHONE NUMBER *
EMAIL FOR INVOICE
**Payment is due immediately upon receiving invoice**
**Late payment fees will be added for every 15 days overdue**
*
HOME ADDRESS *
EMERGENCY MEDICAL CONDITIONS (if applicable) *
EMERGENCY CONTACT *Name, Number & Relationship* *
FIELD HOCKEY SESSIONS WILL BE HELD AT ROCKWOOD SUMMIT HIGH SCHOOL. PAYMENT IS EXPECTED PRIOR TO PARTICIPATING IN ANY PROGRAM. NO REFUNDS WILL BE GIVEN ONE WEEK PRIOR TO THE START OF THE PROGRAM. IN THE EVENT OF INCLEMENT WEATHER AND CANCELLATION--NO REFUNDS OR MAKEUP DATES WILL BE OFFERED. PLAYERS WILL NEED TO BRING A STICK, MOUTHGUARD, SHIN GUARDS, ATHLETIC SHOES & WATER BOTTLE. PARTICIPATION AGREEMENT: I AGREE TO MYSELF PARTICIPATING IN ST. LOUIS FIELD HOCKEY CLUB PROGRAMS AND THAT I WILL COMPLY WITH ALL RULES AND REGULATIONS. I FURTHER AGREE THAT I WILL NOT HOLD ANDREA HOOD, ST. LOUIS FIELD HOCKEY CLUB OR ROCKWOOD SCHOOL DISTRICT OR ANY OF THE AFOREMENTIONED EMPLOYEES RESPONSIBLE IN CASE OF ACCIDENT OR INJURY. I UNDERSTAND THAT NO ACCIDENT INSURANCE IS PROVIDED. I ALSO AGREE TO ABIDE BY THE STANDARDS AND GUIDELINES OF ST. LOUIS FIELD HOCKEY CLUB AND I UNDERSTAND THAT IF I DO NOT FOLLOW THE STANDARDS AND GUIDELINES, I OR MY CHILD MAY BE ASKED TO NO LONGER PARTICIPATE IN ANY STLFHC PROGRAM.
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In consideration of the player (child) listed above being allowed to participate in any way in the related events and activities, the undersigned acknowledges, appreciates, and agrees that: The risks of injury and illness (examples shall include, but are not limited to, communicable diseases such as MRSA, influenza, and COVID-19) to my child from the activities involved in any St. Louis Field Hockey Club related activity are significant, including the potential for permanent disability and death, and while particular rules, equipment, and personal discipline may reduce these risks, the risks of serious injury and illness do exist; and, 1. FOR MYSELF, SPOUSE, AND CHILD, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my child’s participation; and, 2. I willingly agree to comply with the program’s stated and customary terms and conditions for participation. I also willingly comply with all applicable guidelines as related to the current outbreak of COVID-19 which may be outlined by the Federal Government, the CDC, any State, County, or Municipality where St. Louis Field Hockey Club related activities may occur, and any League or Tournament organizations as they relate to ANY ACTIVITY THE RELEASEE PARTICIPATES IN. If I observe any unusual significant concern in my child’s readiness for participation and/or in the program itself, I will remove my child from the participation and bring such attention of the nearest official immediately; and, 3. I myself, my spouse, my child, and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS the RELEASEE NAMED HERE AS St. Louis Field Hockey Club; defined as its directors, coaches, owners, officers, site supervisors, game officials, agents, employees, volunteers, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (“Releasees”), WITH RESPECT TO ANY AND ALL INJURY, ILLNESS, DISABILITY, DEATH, or loss or damage to person or property incidental to my child’s involvement or participation in this program or programs, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES NAMED ABOVE OR OTHERWISE, to the fullest extent permitted by law. The RELEASEE NAMED HERE AS St. Louis Field Hockey Club; defined as its directors, coaches, owners, officers, site supervisors, game officials, agents, employees, volunteers, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (“Releasees”), shall not be responsible for the failure of myself, my spouse, any guardian, or my child or children to abide by the guidelines of the RELEASEE – St. Louis Field Hockey Club as defined above, THE FEDERAL GOVERNMENT, THE CDC; THE STATE, THE COUNTY, AND THE MUNICIPALITY WHERE THE ACTIVITY OCCURS, AND THE LEAGUE OR TOURNAMENT ORGANIZERS as outlined above in Paragraph. 4. I, for myself, my spouse, my child, and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY INDEMNIFY AND HOLD HARMLESS all the above Releasees from any and all liabilities incidental to my involvement or participation in these programs, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent permitted by law.5. I, the parent/guardian, assert that I have explained to my child/ward: the risks of the activity, his/her responsibilities for adhering to the rules and regulations, and that my child/ward understands this agreement. I, FOR MYSELF, MY SPOUSE, AND CHILD/WARD, HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT WE HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. Please sign and date below. *
SOCIAL MEDIA/PHOTO RELEASE: I GIVE ST. LOUIS FIELD HOCKEY CLUB PERMISSION TO TAKE AND SHARE PHOTOS/VIDEO OF MY CHILD ON THE CLUB WEBSITE OR ANY SOCIAL MEDIA PLATFORM FOR ADVERTISING USE. *
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