CENTRAL PENN MINI STICKS
Spring Youth Field Hockey at Twin Ponds West
March 18th, 24th, 31st 4PM – 5PM, April 7th 4PM – 5PM, April 13th 6PM-7PM and
April 14th 3PM – 7PM Tournament
For Grades K through 6 ~ Run by Belinda Heltzel, former 4 X D2 National FH Champion and current Vice-President of the Harrisburg Chapter of Field Hockey Officials ~ The program will consist of instructional sessions and scrimmage time followed by a tournament on April 14th. Tournament hours are dependent on number of teams participating. Players are required to show up with stick, shin guards and mouth guard.
Participant Registration Form
Grade:______________
Last Name:_______________________________ First Name:____________________________________ DOB:_________________
Parent/Guardian Names:___________________________________________________________________
Address: _______________________________________________________________________________
Contact info: (home) ____________ (cell) ______________ e-mail_______________________________
______ $60 SPRING SESSION FEE (includes 4/14 tournament) if registered BEFORE March 1st
______ $75 SPRING SESSION FEE (includes 4/14 tournament) if registered AFTER March 1st
______ $35 STARTER STICK PACKAGE (includes stick, ball, mouth guard, shinguards)
Player’s height in inches for stick size: ________
______ TOTAL (Please make all checks payable to Central Penn Mini Sticks)
______ Parent willing to volunteer as a coach
______ Parent willing to help during games
Experience with field hockey: ________________________________________________________
Youth Shirt Size: S - M - L - XL Adult Shirt Size: S – M – L
Parent/Guardian Statement
This is to confirm that ________________________________, born ______________ has my permission to participate in the Youth Spring Field Hockey League. It is understood that Central Penn Mini Sticks, Belinda Heltzel and her staff is not legally responsible for injury to any participant in this program.
Parent/Guardian Signature:______________________________________________Date:__________________
mail check payable to Central Penn Mini Sticks to
Belinda Heltzel 104 Evergreen Circle, Dillsburg PA 17019
432-0108 bheltzel@gmail.com
