FIELD HOCKEY - VOLLEYBALL - SOCCER - TRACK & FIELD
EE R F RT I H T- S An introduction to girls’ sports taught by MSU student -athletes. Girls ages 8-14 will receive introductory lessons in
FIELD HOCKEY - VOLLEYBALL - SOCCER - TRACK & FIELD
HOW DO I REGISTER Return registration form, waiver and check to Kelsey Withrow. Checks made payable to MSU Athletics. WHAT TO BRING Sneakers, athletic clothing, and waiver. Snack and water will be provided. Girls will NOT be allowed to participate without a waiver. PARKING Parking meters are available next to the building and below the Red Hawk Diner. The Red Hawk parking deck is also available. For detailed directions and parking information please visit www.montclair.edu/welcome/directions.html
Questions? Contact Kelsey Withrow at 973 -655-3201 or via e-mail at [email protected]
Clin 5 1 $ Fee
ic
E FRE T IR T- S H
PLEASE COMPLETE THE REGISTRATION FORM & WAIVER - RETURN TO:
MONTCLAIR STATE UNIVERSITY ATTN: KELSEY WITHROW, ATHLETICS PANZER ATHLETIC CENTER ROOM 118 MONTCLAIR, NJ 07043
NAME __________________________ AGE _______ PHONE ________________ ADDRESS ______________________ CITY ___________ STATE ____ ZIP ______ RSVP BY FEBRUARY 1, 2014 - SPACE IS LIMITED Questions? Contact Kelsey Withrow at 973 -655-3201 or via e-mail at [email protected] *In case of illness or accident, the individual shall have immediate and competent medical care. All such expenses will be billed to the individual’s family medical plan. I acknowledge that at the clinic, my child will participate in a sport that may involve, among other things, physical contact of my child’s body with other persons or objects, including the ground, and accept the risk that my child may sustain an injury. I specifically waive and release Montclair State University and Staff from liability for any claim for damages that I or any child may have for injuries or illness that my child may sustain at the clinic. Montclair State University and clinic staff are not responsible for personal belongings damaged by casualty, theft etc. In signing the application, the parents/guardians certify that their child is in good health with no chronic illness or abnormal tendencies. In the event of an emergency requiring medical care, I authorize the clinic staff, in its best judgment, deems necessary and appropriate treatment. Date:__________ Participant Name:_____________________ ___________ Participant Age:_______________ Signature of Parent/Guardian:________________ Emergency Contact Number:__________ Insurance Carrier:__________________________________
Policy Number:___________
Please note any allergies, asthma or other medical problems:_________________________
FIELD HOCKEY - VOLLEYBALL - SOCCER - TRACK & FIELD
HOW DO I REGISTER Return registration form, waiver and check to Kelsey Withrow. Checks made payable to MSU Athletics. WHAT TO BRING Sneakers, athletic clothing, and waiver. Snack and water will be provided. Girls will NOT be allowed to participate without a waiver. PARKING Parking meters are available next to the building and below the Red Hawk Diner. The Red Hawk parking deck is also available. For detailed directions and parking information please visit www.montclair.edu/welcome/directions.html
Questions? Contact Kelsey Withrow at 973 -655-3201 or via e-mail at [email protected]
Clin 5 1 $ Fee
ic
E FRE T IR T- S H
PLEASE COMPLETE THE REGISTRATION FORM & WAIVER - RETURN TO:
MONTCLAIR STATE UNIVERSITY ATTN: KELSEY WITHROW, ATHLETICS PANZER ATHLETIC CENTER ROOM 118 MONTCLAIR, NJ 07043
NAME __________________________ AGE _______ PHONE ________________ ADDRESS ______________________ CITY ___________ STATE ____ ZIP ______ RSVP BY FEBRUARY 1, 2014 - SPACE IS LIMITED Questions? Contact Kelsey Withrow at 973 -655-3201 or via e-mail at [email protected] *In case of illness or accident, the individual shall have immediate and competent medical care. All such expenses will be billed to the individual’s family medical plan. I acknowledge that at the clinic, my child will participate in a sport that may involve, among other things, physical contact of my child’s body with other persons or objects, including the ground, and accept the risk that my child may sustain an injury. I specifically waive and release Montclair State University and Staff from liability for any claim for damages that I or any child may have for injuries or illness that my child may sustain at the clinic. Montclair State University and clinic staff are not responsible for personal belongings damaged by casualty, theft etc. In signing the application, the parents/guardians certify that their child is in good health with no chronic illness or abnormal tendencies. In the event of an emergency requiring medical care, I authorize the clinic staff, in its best judgment, deems necessary and appropriate treatment. Date:__________ Participant Name:_____________________ ___________ Participant Age:_______________ Signature of Parent/Guardian:________________ Emergency Contact Number:__________ Insurance Carrier:__________________________________
Policy Number:___________
Please note any allergies, asthma or other medical problems:_________________________
