Wildcat Youth Field Hockey - (Pottstown, PA) - powered by LeagueLineup.com

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OJR/Wildcat Youth FH Clinic

PLAYER INFORMATION

* First Name:

* Last Name:

* Grade:

PARENT/GUARDIAN #1

* Firstname:

* Lastname:

* Email:

* Cell Phone:

PARENT/GUARDIAN #2

Firstname:

Lastname:

Email:

Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

* Emergency Contact:

* Phone:

* Relationship to Player:

WAIVER INFORMATION

I, on my own behalf of my spouse, heirs, executors and administrators, voluntarily
and knowingly ASSUME ALL RISK of personal injury and all other hazards from or related to such participation, whether occurring prior to, during or after the Event, and hereby forever RELEASE AND DISCHARGE the Owen J Roberts School District and Wildcat Youth Field Hockey of the foregoing (collectively, "Releasees") of and from any and every claim, demand, right, expense, or action of any kind or nature whatsoever, relating in any way to my participation in the Event, whether caused by the negligence of the Releasees or otherwise; and
(2) I covenant not to sue any of Releasees for or on account of any such injury(ies); and
(3) I assume full responsibility for the risk of bodily injury, death or property damage
which may result from participation in the Event, whether due to the negligence of
Releasees or otherwise, and while in or upon the premises in which the Event is taking
place;
(4) I further release all Releasees from any claim whatsoever on account of first aid,
treatment or service rendered me during my participation in the Event.

I/we agree with the above *

* List dates player will attend (4/12, 4/19, 5/3, 5/17:

* indicates required fields

Two Sessions ($40 total)($20)

Three Sessions ($60 total)($40)

Four Sessions ($80 total)($60)

Online processing fee($2) *