CASFH 2015 Summer Clinic - Carolina All Stars Field Hockey
When: Tuesday, June 16, Wednesday, June 17 Thursday, June 18 Where: Cedar Falls Park 501 Weaver Diary Road, Chapel Hill, NC 27514 Time: 8am – 1pm Cost: $225 per individual Register at www.carolinafieldhockey.com today! What to bring: • • • • • • Field Hockey Stick Spikes /Sneakers Mouthguard & Shinguards Goalies bring own equipment Water & Snacks Sunscreen Direct all questions, comments or concerns to: Meghan Fulton, CASFH Administrator [email protected] CASFH Junior Summer Clinic Waiver Form Medical & Waiver Release: All Participants’ must have their own health insurance coverage. Participants will not be allowed to play unless the following information is submitted and the form is signed by the parent or guardian of the participant. I/We, the undersigned, hereby certify that I (we) am (are) the parent or legal guardian of the player. I hereby give permission for the staff of the Carolina All Stars Field Hockey Clinic, to seek during the period of the clinic appropriate medical attention for the participant and for the medical attention to be given and for the participant to receive medical attention in the event of an accident, injury or illness. I will be responsible for any and all cost of medical attention and treatment. I/We, the undersigned, for ourselves, our heirs, our executors and administrators, waive, release and forever discharge Carolina All Stars Field Hockey Club, its staff, officers, agents, employees, representatives, successors and assigns from any liability, claims, demands, actions and causes of actions whatsoever arising out of or related to any loss, personal injury or property damage that may be sustained or occur during participation in Carolina All Stars Field Hockey Clinic activities or while at Carolina All Stars Field Hockey Clinic. Participant’s Name: ______________________________________________ Participant’s Insurance Company: __________________________________________________________ Policy #: _________________________________________________________________________________________ Parent/Guardian Signature: _____________________________________________ Date: ____________
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