towson university: field hockey prospect day
TOWSON UNIVERSITY: FIELD HOCKEY PROSPECT DAY
REGISTRATION FOR PROSPECT DAY ON APRIL 21ST Name ________________________________________________ Position ____________________ Graduation Year _________ Address ___________________________________________ City ________________________ State _______ Zip __________ Cell phone number of athlete (_____) __________________ Email of athlete _________________________________________ What major are you potentially interested in pursuing while in college? ______________________________________________ Name of high school and coach ______________________________________________________________________________ Name of club and coach ____________________________________________________________________________________ Parent/guardian name _____________________________________________________________________________________
$100 Registration fee includes lunch and a snack for 1 prospective athlete. Please add $10 per parent/guardian who plan to attend. _____ Indicate total additional lunches
☐ Payment/Check included ☐ Will pay with check or cash the day of the clinic
Make Checks payable ($100) to Towson University Field Hockey Mail registration, waiver and payment to: E.A. Jackson Head Field Hockey Coach Department of Athletics 8000 York Rd Towson, MD 21252
MEDICAL WAIVER FORM I understand that field hockey is a physically active sport. Inasmuch, there are inherent risks, including physical injury or death involved in playing. I hereby authorize the staff of Towson University to use their best judgement in any emergency and release them from liability resulting from injury sustained as a result of participation in the camp on behalf of ________________________________________________________________________________________________________ (Player’s name) Towson University assumes no responsibility from personal injury, death, loss or damage to property. I also certify that the above named is physically able to participate in Field Hockey Clinic activities. Signature of parent or guardian ____________________________________________________ Date _____________________ List of all medications that your child takes and any medical conditions the camp or a physician should be aware of: ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ Emergency phone numbers: Daytime ________________________________ Evening __________________________________ Insurance Company ______________________________________________ Policy # __________________________________ Group # __________________________________
REGISTRATION FOR PROSPECT DAY ON APRIL 21ST Name ________________________________________________ Position ____________________ Graduation Year _________ Address ___________________________________________ City ________________________ State _______ Zip __________ Cell phone number of athlete (_____) __________________ Email of athlete _________________________________________ What major are you potentially interested in pursuing while in college? ______________________________________________ Name of high school and coach ______________________________________________________________________________ Name of club and coach ____________________________________________________________________________________ Parent/guardian name _____________________________________________________________________________________
$100 Registration fee includes lunch and a snack for 1 prospective athlete. Please add $10 per parent/guardian who plan to attend. _____ Indicate total additional lunches
☐ Payment/Check included ☐ Will pay with check or cash the day of the clinic
Make Checks payable ($100) to Towson University Field Hockey Mail registration, waiver and payment to: E.A. Jackson Head Field Hockey Coach Department of Athletics 8000 York Rd Towson, MD 21252
MEDICAL WAIVER FORM I understand that field hockey is a physically active sport. Inasmuch, there are inherent risks, including physical injury or death involved in playing. I hereby authorize the staff of Towson University to use their best judgement in any emergency and release them from liability resulting from injury sustained as a result of participation in the camp on behalf of ________________________________________________________________________________________________________ (Player’s name) Towson University assumes no responsibility from personal injury, death, loss or damage to property. I also certify that the above named is physically able to participate in Field Hockey Clinic activities. Signature of parent or guardian ____________________________________________________ Date _____________________ List of all medications that your child takes and any medical conditions the camp or a physician should be aware of: ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ Emergency phone numbers: Daytime ________________________________ Evening __________________________________ Insurance Company ______________________________________________ Policy # __________________________________ Group # __________________________________
