HVFC Winter Program 09/10 - REGISTRATION FORM

 (To be printed, then completed)

 

Clinic Name

Cost

Day

Age

Skills Clinic

$70

Thursday / Saturday

U8-U18

Advanced Skills Clinic

$85

Monday / Saturday

U8-U18

Speed & Agility Clinic

$60

Saturday

U8-U18

Adult 4v4

$25

Friday

26+

 

Clinic Name (CIRCLE ONE ABOVE)

 

Player Name:                                                                                                                                                                                                                                                                                                                                                                                                                                                          

Player Age:                                                                                              Player Grade:                                                                                                                                                                                                                                      

 

Player Address:                                                                                                                                                                                                                                                                                                                                                                                                                                                                   

                                                                                                                                                                                                                                                                                               

                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            

 

Emergency Contact #:                                                            Email Address:                                                                                                                                                                                                                                              

Medical Insurance Name & Policy Number:                                                                                                                                                                                                                                                                                                                                                  

 

I, the undersigned parent or guardian, do hereby authorize the HVFC trainer or coaches to secure any & all medical treatment in the event that I cannot be contacted. I further authorize any attending physician to render any and all medical care which he or she may deem necessary. It is understood that, in any event, an attempt will be made to contact the parent before treatment is started. I, the undersigned parent or guardian, also certify that my child is physically fit to attend and participate in all clinic activities.

 

Parent/Guardian Signature:                                                                                                                                          Date: