LCHS Field Hockey Clinic 2025

We are so excited to announce our clinic for our field hockey players!

Ages: 4-14

Date: Friday, September 12, 2025

Time: 6-8pm

Place: Loudoun County High School

415 Dry Mill Rd SW

Item Description Price Qty

Field Hockey Clinic
All campers will receive a small giveaway! $35.00

#1	Student First Name Student Last Name Age*	copy
#2	Student First Name Student Last Name Age*
#3	Student First Name Student Last Name Age*
#4	Student First Name Student Last Name Age*
#5	Student First Name Student Last Name Age*
#6	Student First Name Student Last Name Age*
#7	Student First Name Student Last Name Age*
#8	Student First Name Student Last Name Age*
#9	Student First Name Student Last Name Age*

Home Information

Home Address

City / State / Zip

Home Phone

Primary Emergency Contact

Full Name

Relationship

Contact Number

Email Address

Secondary Emergency Contact

Full Name

Relationship

Secondary Contact Number

Medical Information

Primary Doctor

Primary Doctor Phone Number

Insurance Company Name

First and Last Name of Policy Holder

Policy Number

Medical Allergies

Additional Information

Authorized Drivers

Students will be released to primary and secondary contacts. Please add any additional authorized drivers in this field.

Waiver

Participant Name

Waiver*

As the parent and/or legal guardian of the participant stated above, I have given my child permission to participate in the LCHS Cheer Clinic May 17, 2025, and I certify that he/she/they is/are in good health and can take part in all camp activities. I fully understand that participation in the LCHS Cheer Clinic May 17, 2025 may involve serious risks and danger that may result in harm, bodily injury and death. While particular rules, equipment, and personal discipline may reduce the risk, I acknowledge the risk of serious injury does exist. In the event of an emergency or an injury occurs, I authorize the camp staff members to take all proper action and use the emergency service available at the nearest hospital if necessary. I understand my personal insurance will be used in this case. I, for myself and on behalf of the participant hereby release and hold harmless against any claims, damages, and expenses Loudoun County Athletic Booster Club, Kara Griffin, Kim Norton and any of their directors, officials, agents, volunteers and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of the premises used to conduct the event. I acknowledge and agree that LCHS Cheer Clinic and Loudoun County Athletic Booster Club retain the right to use photographs and videos taken of the event participants for publicity and advertising purposes. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENTS.

Parent/Guardian First Name

Parent/Guardian Last Name

Players must wear athletic gear and bring a water bottle.

Registration deadline is 9/5/25, 11:59pm.

Registration can be paid online with the following fees: