Step 1 of 4 - Registration Information 25% Player Name/"Nickname"* First Last Date of Birth* Player's Grade (NEXT school year = September 2024)*KindergartenGrade 1Grade 2Grade 3Grade 4Grade 5Grade 6Grade 7Grade 8Grade 9T-Shirt Size*Youth Small T-ShirtYouth Medium T-ShirtYouth Large T-ShirtAdult Small T-ShirtAdult Medium T-ShirtAdult Large T-ShirtAdult X-Large T-ShirtMailing Address Update*New Player - Please fill in address belowReturning Player - SAME address as last yearReturning Player - NEW addressMailing Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Parent/Guardian Name* First Last Parent/Guardian Phone*Parent/Guardian Email* Enter Email Confirm Email Emergency Contact Name* First Last Emergency Contact Phone*Emergency Contact's Relationship to Player*Family Physician* First Last Physician Phone*Family Dentist* First Last Dentist Phone*Are you a returning player?*Yes (thanks for coming back!)No (we look forward to meeting you!)Player Level*Level One: Entering Kindergarten-3rd GradeLevel Two: 4th Grade-6th GradeLevel Three: 7th Grade-9th GradePlayer Experience*Beginner (never played before)Intermediate (recreational/camps)Advanced (have played on a school club/team)Teammate Request (1 Only)We will do our best to match teammates ... there is no guarantee.ALL FORMS AND FEES MUST BE COMPLETE FOR CAMPER TO BE OFFICIALLY REGISTERED CURRENT PHYSICAL/IMMUNIZATIONS MUST BE UP TO DATE BY THE FIRST DAY OF CAMP Physical Status*Physicals may be attached to an email addressed to vicky@realfieldhockey.com or mailed to R.E.A.L. Field Hockey, Inc. 17 Elmwood Street Maynard, MA 01754I have mailed/electronically attached an updated physicalPhysical is NOT current and will send a copy BEFORE campDate of current physical* Activity Restrictions (if yes please list below)*YesNoActivity RestrictionsCurrent medications (if yes please list name and dosage below)*YesNoCurrent Medications (name and dosage)Medical Conditions/History (if yes please list below)*YesNoMedical Conditions/HistoryAllergies (if yes please list below and complete linked form by start day)*YesNoPlease complete and bring this medical release for the start day if player has allergies.AllergiesDrug Reactions (If yes please list below)*YesNoDrug ReactionsInsurance InformationCarrier Name*Policy Holder Name* First Last Policy Holder's relationship to camper*I, the parent/guardian of ________________________________________ (enter below), give permission for my child to receive emergency medical or surgical treatment and hospitalization if necessary. I understand that every attempt will be made to contact me or the named emergency contact before taking action. I hereby waive, release, indemnify and hold harmless R.E.A.L. Field Hockey, Inc., staff, camp management, agents and sponsors from any liability for any damages, accidents, injury or illness incurred while at camp. I UNDERSTAND THAT THERE IS A RISK OF INJURY TO MY CHILD AS A RESULT OF CAMP ACTIVITIES, AND KNOWINGLY AND VOLUNTARILY ASSUME ALL RISK OF SUCH INJURY. I will be financially responsible for any medical attention needed during camp. Player's Name* First Last *By checking this box, I certify that all information above is accurate. I agree Photography Release (REQUIRED) This passage confirms the agreement between you and R.E.A.L. Field Hockey, Inc. regarding your participation in approved activities in which you may be photographed or videotaped from time to time. For valuable consideration received, you hereby irrevocably grant to R.E.A.L. Field Hockey, Inc. perpetually, exclusively, and for all media throughout the world (including print, nontheatrical, home video, CD-ROM, internet and any other electronic medium presently in existence or invented in the future), the right to use and incorporate (alone or together with other materials), in whole or in part, photographs or video footage taken of you as a result of your participation in approved activities of R.E.A.L. Field Hockey, Inc. You hereby agree that you will not bring or consent to others bringing claim or action against R.E.A.L. Field Hockey, Inc. on the grounds that anything contained in the Property, or in the advertising and publicity used in connection herewith, is defamatory, reflects adversely on you, violates any other right whatsoever, including, without limitation, rights of privacy and publicity. You hereby release R.E.A.L. Field Hockey, Inc., its directors, officers, successors and assigns from and against any and all claims, demands, actions, causes of actions, suits, costs, expenses, liabilities, and damages whatsoever that you may hereafter have against R.E.A.L. Field Hockey, Inc. This agreement shall not obligate R.E.A.L. Field Hockey, Inc. to use the Property or to use any of the rights granted hereunder, or to prepare, produce, exhibit, distribute or exploit the Property. R.E.A.L. Field Hockey, Inc. shall have the right to assign its rights hereunder, without your consent, in whole or in part, to any person, firm or corporation. I understand that these pictures will be accessible to anyone with Internet access and may be used in instructional settings, however, no names of subjects will be published. Photography Release*I agree to and accept the aboveI disagree to the above and DO NOT want my child photographed Please read carefully: Camp fee (no online payment available): MAIL CHECK TO: R.E.A.L Field Hockey, Inc. 17 Elmwood Street Maynard, MA 01754 Payment Status - Registration is CONFIRMED ONLY when fee is received (via VENMO @Pam-Spuehler or Check)*- [ ] $425.00/athlete Before April 1 - $25.00 OFF - VENMO/check must be received by April 1st- [ ] $450.00/athlete - Register between April 1st-June 1st- [ ] $485.00/athlete - Register after June 1st- [ ] $420.00/athlete - Family/sibling discount (2+ athletes from the same family) Payment/Refund/Cancellation Policy: The $100.00 registration processing fee is non-refundable. In the event you must cancel your reservation, you will receive a refund as defined below: Cancellation notice must be submitted in writing. Please email pamela.spuehler@gmail.com Refund will be issued at the end of camp. 50% of tuition paid will be refunded if written notice is received 2 weeks or less prior to session start date. Cancellations received at start date forfeit full registration fee. Cancellation requests due to illness or accident prior to the camp session start date require a physician's written verification. Upon receipt of verification, we will issue a full refund. Make Checks Payable to 'REAL FIELD HOCKEY" or Venmo @Pam-SpuehlerSend checks to address below: Pamela Spuehler 39 Palmer St Chelsea, MA 02150Do you have any Questions or Concerns for R.E.A.L. Field Hockey Camp? Thank you for your support and we look forward to another successful camp.
