2015 KUTZTOWN UNIVERSITY
FIELD HOCKEY
INDOOR TOURNAMENTS
Who: U12, U14, U16, and U19 Club Teams & High School Teams are welcome!
Dates: Sunday, February 1st (U16 and U19), Sunday, February 15th (U16 and
U19), and Sunday, March 1st (U12 and U14)
Where: Keystone Field House (Kutztown University Campus)
Details: New 5 v 5 format (including GK), Following FIH recommendations, Guaranteed 4 X 25 minute games, Awards for 1st place team in each division
Fees: $350.00 PER TEAM (Discount for multiple teams). Please, make checks
payable to K.U. Field Hockey and send to: Marci Scheuing, 201 Keystone Hall,
Kutztown University, Kutztown, PA 19530. Fee must be received to register.
Rules: FIH Rules with Certified Officials
Contact: Head Coach—Marci Scheuing, [email protected] or 610-683-4378,
Assistant Coach—Amber Aulenbach, [email protected].
Entry Deadline: January 10, 2015, Please see attached Entry Form and Waiver
NAME OF TEAM: ___________________________
COACH: ___________________________________
HOME #(
)
CELL#(
)
WORK #(
)
PREFERRED TOURNAMENT DATE/S (Please include age group): ______________________
E-MAIL: ________________________________
ADDRESS:
_______________________________________________
________________________________________________
________________________________________________
ROSTER:
1.
6.
2.
7.
3.
8.
4.
9.
5.
10.
RETURN WITH CHECK PAYABLE TO: KU FIELD HOCKEY
SEND TO:
Marci Scheuing
FIELD HOCKEY COACH
201 KEYSTONE HALL
KUTZTOWN UNIVERSITY
KUTZTOWN, PA 19530
WAIVER FORM
I understand that I am financially responsible for any medical bills incurred by me during
my participation in the Golden Bear Indoor Tournament. In case of emergency, I grant permission for emergency treatment to be given to me by the appropriate medical personnel.
In consideration of the use of premises or facilities owned or operated by Kutztown University and/or in consideration of permitting to participate in the activity listed above, on behalf
of myself, my heirs, executors, administrators, successors or assigns. I hereby release and forever
discharge Kutztown University, its agents, servants and employees of and from any and all manner of actions, causes of action, suits, damages, claims and demands, on account of personal injury, including death, or any other cause whatsoever, which I may have against them by reason of
or arising in the above-listed activity.
TEAM NAME: _____________________________
TEAM ROSTER:
PRINT NAME:
FULL SIGNATURE:
1. _____________________
1. ____________________
2. _____________________
2. ____________________
3. _____________________
3. ____________________
4. _____________________
4. ____________________
5. _____________________
5. ____________________
6. _____________________
6. ____________________
7. _____________________
7. ____________________
8. _____________________
8. ____________________
9. _____________________
9. ____________________
10. _____________________
10. ____________________
NOTE: WAIVER FORM MUST BE COMPLETED AND SUBMITTED PRIOR TO COMPETITION IN ORDER TO PARTICIPATE.***Coaches: Kutztown University is committed to promoting good sportsmanship. Poor sportsmanship or unethical behavior will not be tolerated.
Please understand that you are responsible for the conduct of your team, their parents and any
spectators.
________________________________ (please sign)