Mini POGO Registration Form 2012

Mini POGO Registration Form
Program Description: Open play field hockey for girls & boys ages 10 and under Location:
Held at the Escondido Sports Center on the indoor rinks Dates & Time: June 8, 15, 22, 29
July 13, 20, 27 at 4:15pm
INDIVIDUAL REGISTRATION FORM:
Name:__________________________________________________________________
Age:________
Grade:________
School:____________________________________
Parent Contact Name & Phone:_______________________________________________
Emergency Contact Name & Phone:___________________________________________
TO REGISTER:
Mail in Individual Registration Form along with check for $50.00 per player (Cost remains the
same for any or all play dates).
Make Check Payable to: RUSH Field Hockey
Mail Registration Form and Fee to: 681 Sparta Drive, Encinitas, CA 92024
DEADLINE: Rolling Registration. Enrollment limited on a first come, first serve basis.
MEMBERSHIP: Each player must be a RUSH member to be eligible to participate.
RUSH membership is required before participation. Players not registered as a member will
be ineligible to participate. RUSH memberships are available online at
www.rushfieldhockey.org, click on Membership, fill out the Membership Registration Form and
submit. Membership cost is $35.00 per player and is valid for all 2012 programs. Members
only need to join once per calendar year.
CONTACT: Brian, sdcoach@rushfieldhockey.org or go to www.rushfieldhockey.org
For Office Use Only:
Total:
Check #: