Long Island FH Registration

Medusa Field Hockey Summer Camp 2025

Players First Name:

Players Last Name:

Players Grade (as of Sept '25)

USA Field Hockey Number (for insurance purposes)

Parent Email Address:

Phone Number (in case of emergency):

Is there anything you think we need to know about your daughter (allergies, diagnosis, etc)?

I understand that my daughter is participating in a contact sport with Medusa Lacrosse LLC and understand my daughter can get injured/result in death due. I am releasing Medusa Lacrosse LLC and any staff members from being held accountable if such an event may happen. I also understand that Medusa Lacrosse LLC will be taking pictures and videos of my child and using them for advertisement purposes, only.

Parent/Guardian Signature:

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Medusa Field Hockey Summer Camp 2025

Medusa Field Hockey Summer Camp 2025$350

Medusa Athletics Lacrosse & Field Hockey

Medusa Athletics
Lacrosse & Field Hockey