TPHS Field Hockey Pick Up Games

* REGISTRATION INSTRUCTIONS *

To register, please add a "1" to select your session(s) and to begin your registration.
Read and confirm your understanding of the parent waiver and release. CLICK HERE TO VIEW OR DOWNLOAD WAIVER
Provide your payment information and click "Submit Payment" to complete your registration. Accepted forms of payment include ACH payments, debit cards, credit cards, Google Pay, and Apple Pay.
All fields must be completed to submit your registration.

If you need assistance or have questions about signing up, contact cspleen5@gmail.com.

Selection

Pick Up-Full Summer$75.00

Qty

Sub Total$0

Pick Up-June Only (3rd, 10th, 17th & 24th)$50.00

Qty

Sub Total$0

Pick Up-July Only (15th, 22nd, 29th)$40.00

Qty

Sub Total$0

Pick Up-Drop In (Single Session)$20.00

Qty

Sub Total$0

Participant Information

Participant First Name

Participant Last Name

Age

Health History

If no conditions exist enter NONE. Please list and describe all physical or emotional limitation(s) your child may have, including but not limited to: Allergies, Vision, Asthma, Heart Murmur, High Blood Pressure, etc.

Insurance Information

By checking this box, you confirm that the participant listed on this registration form is covered by health Insurance and that the health information provided on this registration form is accurate.

Health Insurance Carrier

Health Insurance Policy Number

Parent Waiver and Electronic Consent Agreement

If 18 or over, please sign for yourself

By checking this box you confirm that you have read and agree to all terms in the above SDUHSD/TPHSF HOLD HARMLESS, RELEASE OF LIABILITY AGREEMENT FOR EXTRA CURRICULAR ACTIVITIES AND THE PARENT RELEASE AND CONSENT WAIVER.

By checking this box, you agree to the use of your ELECTRONIC CONSENT in lieu of an original signature on paper. You have the right to request to sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged and no special hardware or software is required to view it. Make sure that we have your current email address. I agree via electronic consent to the terms above.

Contact Information

Parent First Name

Parent Last Name

Address 1

Address 2

City

State/Province

Postal Code

Country

Phone Number

Email Address

Yes, I would like to receive email communications.Yes, I would like to receive email communications.

Payment Information

Discount Code (if you have been provided with a code, please enter here)

Card Number

Card Type

Expiration Month

Expiration Year

CVV Code

Name On Card

Account Number

Routing Number

Name On Account

Account TypeCheckingSavings

Billing Address 1

Billing Address 2

Billing Postal Code

Billing City

Billing State

Billing Country

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