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Burnt Hills
Field Hockey
Field Hockey
Home
About
Roster
Schedule
Coaches
Records
Awards
Alumni
Photos
Bulletin
BH Camps/Clinics
Forms
BHBL Medical Form
Links
Youth
Locations
Opportunities
Teams
Varsity
JV
Modified
Registration - 2025 MEDICAL FORM
2025 MEDICAL FORM
We must have an up to date MEDICAL FORM on file for all players participating in any of our Field hockey Camps/Clinics.
Name
Phone
EVENT (Team Camp, Youth Playday, Fall Ball, Youth Summer Camp, Indoor Clinic, etc..)
Contact Email
NAME OF EVENT
EMERGENCY CONTACT
Parent's Name/Number
EMERGENCY NAME/NUMBER
HOSPITAL CHOICE IN EMERGENCY
Known Allergies, peanut, bee, etc..
Last Tenatus Immunization Date
Recent Injuries, illnesses or pertinent information
Comments
I hereby give my child permission to participate in all activities a the BHBL field hockey event listed above. I verify that she/he is physically able to participate in all activities. If necessary, I allow my child to be treated by a doctor or athletic trainer while attending the event. Furthermore, I authorize my child to be transported to a local hospital should she/he require medical attention. I am fully aware that the event does not provide primary medical insurance for its participants. I am prepared to accept full responsibility for injuries or medical complications/interventions that may be required from participating in this event.
I have read and agree to all terms and conditions above
Parent or Guardian Initials for Consent