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REGISTRATION FORM
BAY AREA YOUTH FIELD HOCKEY PROGRAM
Fall 2011

Last Name:
First Name:
Parent's Last Name:
Parent's First Name:
Email:
Phone # (home):
Address:
City:
State:
Zip:
Date of Birth MM/DD/YY:
Grade:
Male/Female:
Played before?:
If Yes, how many years?
Own stick?
Tshirt Size:
Insurance: USFHA membership covers liability insurance only! You
will need to show proof of USFHA membership by the first day of play.
You need your own health and dental coverage!
USFHA Membership #
Exp Date:
Insurance Provider:
Primary Physician Name:
Primary Physician Phone:
Dentist Name:
Dentist Phone:
 
Parent volunteer opportunities:
 
How did you hear about this program?
 
Would you like your contact information to be shared with other parents
to set up carpooling?
 
Comments: