Long Island FH Registration

Medusa Field Hockey
Summer Camp 2024

Players First Name

Phone Numbe (in case of emergency):

Players Last Name:

Email Address (to be used for camp updates):

USA Field Hockey Number (for Insurance Purposes Only):

I, for myself or as the parent or legal guardian of the above named registrant recognize the possibility of serious physical injury or death associated with physical activities including field hockey. I, from this day forward hereby forever release, discharge, hold harmless, Medusa LLC, it’s employees, representatives, agents, and associated personnel against any and all claims, causes of actions, and/or liability by or on behalf of the registrant as a result of the registrants’ participation in Medusa LLC events. in any and all of the practices, camps, special events, league events, tournaments, and showcases (hereinafter collectively "Events") including but not limited to traveling to and from such events locally and out of state. I hereby consent and agree that Medusa LLC has the right to take photographs and/or videos of the above named registrant for feedback, social media (facebook, instagram, Medusa Athletics website), advertising, and marketing. I AM SIGNING THIS DOCUMENT WITH AN ELECTRONIC SIGNATURE AND I AGREE THE SAME SHALL BE CONSIDERED AN ORIGINAL. ******PLEASE PRINT PARENT/GUARDIAN NAME BELOW********

Your Signature

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Thank You! See you on the field!

Medusa Athletics
Lacrosse & Field Hockey

Medusa Field Hockey
Summer Camp 2024

Please Be Patient While the Next Screen Pops Up

Medusa Lacrosse & Field Hockey

Medusa Athletics Lacrosse & Field Hockey

Medusa Field Hockey Summer Camp 2024

**Please Be Patient While the Next Screen Pops Up**

Medusa Athletics
Lacrosse & Field Hockey

Medusa Field Hockey
Summer Camp 2024

Please Be Patient While the Next Screen Pops Up