Saint Gertrude field hockey spring clinics

Lady Gator Spring Field Hockey Series

Child's First Name*

Child's Last Name*

Child's Gender*

Projected H.S. Graduation Year*

Grade in Fall 2024*

Age as of 7/31/2025*

Current School in Fall 2024*

Parent First Name*

Parent Last Name*

Parent Email*

Phone Number*

Street Address*

City*

State/Region*

Postal Code*

Guardian's address, phone, email if different

Health Insurance Coverage and Subscriber's Name*

How many years have you played this sport?*

For What Team?*

What position do you play or are you interested in playing?*

Emergency Medical Treatment*

NOTE: By signing this form the parent/guardian is giving permission for their child to participate in the Saint Gertrude High School summer camps and consents to emergency medical treatment.

I, the parent/guardian, authorize and consent to emergency medical and/or non-emergency minor first aid treatment for my child/ward while enrolled as a participant in a Saint Gertrude High School Summer Camp. The Athletic Director, the Benedictine School of Richmond's athletic trainer, and personnel have my permission, in an emergency when I cannot be contacted, to take my child/ward to receive treatment that a physician deems necessary for the well-being of my child/ward. (If there is an objection to seeking emergency care, a statement should be provided by the parents/guardians that states their objection and the reason for objection.)

I Agree

Waiver/Release of Liability Hold Harmless Agreement*

I understand that there is risk inherent in any sporting activity. I certify that my child is in good health and fully able to participate in the spring field hockey clinics. My child is covered by medical insurance. In consideration of being allowed to enroll in The Saint Gertrude High School Spring Field Hockey Clinics, the participant and the parent or guardian of the participant do hereby agree for ourselves, our heirs, executors and administrators to release, hold harmless and forever discharge the Athletic Director, the Benedictine School of Richmond's athletic trainer, the employees, coaches, students, and affiliates against any and all claims, actions, causes of actions, suits, judgments, and demands whatsoever arising directly, or indirectly, in connection with the participant’s association with or participation in Saint Gertrude High School Spring Field Hockey Clinics. By signing below and agreeing to the terms set forth, I acknowledge that I have read and understood this form and further understand that the terms herein are contractual and not mere recital.

I Agree

Parent/Guardian Electronic Signature*

Spring Field Hockey Clinic

Spring Field Hockey Clinic - April 16 $25

Spring Field Hockey Clinic - April 30 $25

Spring Field Hockey Clinic - May 7 $25