High School Teams
CRUSADER FIELD HOCKEY PAGODA CUP 2017
High School Teams
11 v 11 Full Field Tournament play Minimum of four 25 minute games followed by a championship game
DATE:
SATURDAY, AUGUST 12TH
COST:
$300 per team plus $20 cash per game played for official fee Registration fee must be received to hold team spot in tournament
VENUE:
Alvernia University Turf Field 460 Saint Bernardine Street (GPS) Reading, PA 19607
ENTRY DEADLINE: JULY 14TH, 2017
9:00 AM START (Rain date Aug. 13th)
REGISTER EARLY TO HOLD YOUR SPOT!!!
CONTACT: LAURA GINGRICH @ 484-256-5320 OR EMAIL [email protected] Checks made payable to: “Alvernia University Field Hockey” Send to: LAURA GINGRICH, FIELD HOCKEY COACH, ALVERNIA UNIVERSITY 400 Saint Bernardine Street, Reading, PA 19607
RELEASE AND WAIVER – To be completed by every player on the team roster. Intending to be legally bound, I, the undersigned, individually and as parent/guardian of ____________________________________________________ a minor, ask that he/she be admitted to participate in the Crusader Field Hockey Pagoda Tournament, sponsored by Alvernia University, and Coach Staff. In consideration of such admission, I do hereby agree to release, discharge, and hold harmless, Alvernia University, Coaching Staff, team members, its officers, agents, and employees of and from all causes, liabilities, damages, claims, or demands whatsoever on account of any injury or accident involving the said minor arising out of the minor’s attendance at the Field Hockey Tournament or in the course of competition and/or activities held in connection with the tournament.
Parent/Guardian Signature
Date
MEDICAL TREATMENT AUTHORIZATION I hereby authorize the coaches/staff involved in the Field Hockey Tournament to act for me, the parent/guardian of __________________________________________________, a minor, according to their best judgment, in any emergency and/or when medical attention is required. Medications: ___________________________________________________________________ Allergies: ___________________________________________________________________
Parent/Guardian Signature
Date
Health Insurance Provider: _______________________________________________________________ Policy #: ___________________________________________________________________
TEAM ROSTER NAME OF TEAM: __________________________________________ COACH: __________________________________________________ HOME # (______________________) CELL# (____________________________ ) E-MAIL: _____________________________________ ROSTER: (Maximum size 18) 1.
10.
2.
11.
3.
12.
4.
13.
5.
14.
6.
15.
7.
16.
8.
17.
9.
18.
RETURN ROSTER & WAIVERS WITH CHECK PAYABLE TO: ALVERNIA FIELD HOCKEY SEND TO: LAURA GINGRICH, FIELD HOCKEY COACH, ALVERNIA UNIVERSITY 400 Saint Bernardine Street, Reading, PA 19607
High School Teams
11 v 11 Full Field Tournament play Minimum of four 25 minute games followed by a championship game
DATE:
SATURDAY, AUGUST 12TH
COST:
$300 per team plus $20 cash per game played for official fee Registration fee must be received to hold team spot in tournament
VENUE:
Alvernia University Turf Field 460 Saint Bernardine Street (GPS) Reading, PA 19607
ENTRY DEADLINE: JULY 14TH, 2017
9:00 AM START (Rain date Aug. 13th)
REGISTER EARLY TO HOLD YOUR SPOT!!!
CONTACT: LAURA GINGRICH @ 484-256-5320 OR EMAIL [email protected] Checks made payable to: “Alvernia University Field Hockey” Send to: LAURA GINGRICH, FIELD HOCKEY COACH, ALVERNIA UNIVERSITY 400 Saint Bernardine Street, Reading, PA 19607
RELEASE AND WAIVER – To be completed by every player on the team roster. Intending to be legally bound, I, the undersigned, individually and as parent/guardian of ____________________________________________________ a minor, ask that he/she be admitted to participate in the Crusader Field Hockey Pagoda Tournament, sponsored by Alvernia University, and Coach Staff. In consideration of such admission, I do hereby agree to release, discharge, and hold harmless, Alvernia University, Coaching Staff, team members, its officers, agents, and employees of and from all causes, liabilities, damages, claims, or demands whatsoever on account of any injury or accident involving the said minor arising out of the minor’s attendance at the Field Hockey Tournament or in the course of competition and/or activities held in connection with the tournament.
Parent/Guardian Signature
Date
MEDICAL TREATMENT AUTHORIZATION I hereby authorize the coaches/staff involved in the Field Hockey Tournament to act for me, the parent/guardian of __________________________________________________, a minor, according to their best judgment, in any emergency and/or when medical attention is required. Medications: ___________________________________________________________________ Allergies: ___________________________________________________________________
Parent/Guardian Signature
Date
Health Insurance Provider: _______________________________________________________________ Policy #: ___________________________________________________________________
TEAM ROSTER NAME OF TEAM: __________________________________________ COACH: __________________________________________________ HOME # (______________________) CELL# (____________________________ ) E-MAIL: _____________________________________ ROSTER: (Maximum size 18) 1.
10.
2.
11.
3.
12.
4.
13.
5.
14.
6.
15.
7.
16.
8.
17.
9.
18.
RETURN ROSTER & WAIVERS WITH CHECK PAYABLE TO: ALVERNIA FIELD HOCKEY SEND TO: LAURA GINGRICH, FIELD HOCKEY COACH, ALVERNIA UNIVERSITY 400 Saint Bernardine Street, Reading, PA 19607
