Medusa Field Hockey Winter 2025 Travel Team Membership

Players First Name:

Players Last Name:

Email Address (to be used for team updates):

Phone Number (in case of emergency):

Players Birthdate:

Month

Day

Year

Players Grade:

3rd

4th

Players USA Field Hockey Number (for insurance purposes):

I allow Medusa Larosse LLC to use pictures/videos of my child for advertising purposes and future events for Medusa Lacrosse LLC. I also understand that I am releasing Medusa Lacrosse LLC from any liability if my daughter is injured and/or such injury results in death. I understand that I am taking a risk by allowing my child to participate in a contact sport and release Medusa Lacrosse LLC and all staff members from any type of liability.

Guardian/Parent Signature:

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Product

Winter 2025 Field Hockey Team Membership (price includes processing fees)$645

Medusa Athletics Lacrosse & Field Hockey

Medusa Field Hockey Winter 2025 Travel Team Membership

Medusa Athletics
Lacrosse & Field Hockey