HEARTLAND FIELD HOCKEY

Skills, Drills & Fun – Grades 4-8

REGISTRATION FORM

Location: Resolute Athletic Complex (used to be the Sports Barn at Easton)

3599 Chiller Lane, Columbus, OH 43219 – PH: 614-337-4502

Each session will focus on developing strong basic skills using fun drills and small game play.

Conditioning drills, skill drills, outdoor sticks used only.

Sessions are on field turf.

February 3 thru April 7, 2014 - Mondays 4:30pm - 6:00pm Total of 10 sessions

Each session will focus on developing strong basic skills using fun drills and small game play.

Players will be grouped by age/skill level

FEE: $175

A non-refundable $50 deposit is required to secure a spot. Balance is due by January 15, 2014

Make Checks payable to:Heartland Field Hockey

Mail to:PO Box 307283

Gahanna, OH 43230

Please include signed waiver with registration form.

Please PRINT or type

Name: ______

Parent Name: ______

Address:______City: ______Zip: ______

Home Ph: ( )Cell Ph: ( )

Email: ______

School: ______Date of Birth: ______

Current grade: ______School or Club Team: ______

Heartland Field Hockey Waiver

PLEASE PRINT

Name: ______Date of Birth: ______

Address: ______

StreetCityStZip

Contact Phone Number:______Relationship:______

Alternate Phone Number: ______Relationship:______

Waiver and Release of Liability

In Consideration of being allowed to participate in any way in the Heartland Field Hockey, related events and activities, the undersigned acknowledges, appreciates and willingly agrees that:

  1. I will comply with the stated and customary terms and conditions for participation. If, however, I observe and unusual significant hazard during my presence or participation. I will remove myself from participation and bring such to the attention of the nearest coach or official immediately; and
  1. I acknowledge and fully understand that each participant will be engaging in activities that involve risk or serious injury, including permanent disability and death, and severe social and economic losses which may result not only from their own actions, inactions or negligence but the action, inaction or negligence of other, the rules of play, or the condition of the premises or of any equipment used. Further, I accept personal responsibility for the damages following such injury, permanent disability or death; and
  1. I knowingly and freely assume all such risk, both known and unknown, even those arising from the negligent acts or omissions of others, and assume full responsibility form my participation; and
  1. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, hereby release, hold harmless Heartland Field Hockey, its officers, officials, affiliated clubs, their respective administrators, directors, agents, coaches, and other employees of the organization, other participants, sponsoring agencies advertisers, and, if applicable, owners and lessors of premises used to conduct the event, all of which hereinafter referred to as “releasees” with respect to all and any injury, disability, death or loss or damage to person or property, whether arising from te negligence of the releasees or otherwise, to the fullest extent permitted by law.

I have read this release of liability and assumption of risk agreement, fully understand its terms, and understand that I have given up substantial rights by signing it and sign it freely and voluntarily without any inducement.

Participants signature if 18 or older: ______

Parent or Guardian if under 18:______

Printed Name: ______Date: ______