Registration Form - 2025 Fall Clinic

Athlete *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Age Group *

U14

U12

U10

U8

Birthday *

MM

DD

YYYY

Athlete Phone *

(###)

###

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USA Field Hockey Membership # Expiration *

MM

DD

YYYY

Parent/Guardian Phone *

(###)

###

####

Parent/Guardian *

First Name

Last Name

Parent/Guardian Phone *

(###)

###

####

Emergency Contact *

First Name

Last Name

Emergency Contact Phone # *

(###)

###

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Policies and Procedures *

I have read, understand, and agree to the Policies and Procedures as listed on the website.