Saturdays April 6^th, 13^th and 20^th at 5:00 and

April 27^th Tournament 3PM – 7PM(Hours depend on teams entered)

For Grades K through 6 ~ Run by Belinda Heltzel, former 4 time Division 2 National FH Champion and former 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 27^th   Tournament hours are dependent on the number of teams participating.  Players are required to show up with stick, shin guards and mouth guard.

Participant Registration Form            

Grade:______________  School You Attend__________________________________________________

Last Name:_______________________________ First Name:____________________________________  DOB:_________________ 

Parent/Guardian Names:___________________________________________________________________ 

Address: _______________________________________________________________________________

Contact info:   (home) ____________   (cell) ______________ e-mail_______________________________      

______   $60 SPRING SESSION FEE (includes 4/27 tournament) if registered BEFORE March 23rd   

______   $70 SPRING SESSION FEE (includes 4/27 tournament) if registered AFTER March 23rd   

______   $40 STARTER STICK PACKAGE (includes stick, ball, mouth guard, shinguards)

Player’s height in inches for stick size:  ________

            *New this session… $10 discount if returning player from winter session and does not need new jersey,

                        Winter jersey color and number:___________________________________________________

            *New this session… $10 discount for players who live in Northern School District

______   TOTAL  (Please make all checks payable to Central Penn Mini Sticks)

            ______   Parent willing to volunteer as a coach

______   Parent willing to help during tournament

Experience with field hockey: ________________________________________________________

Youth Shirt Size:  S  -  M  -  L   Adult Shirt Size: S – M – L  *Please note shirts are dryfit and sizes run a little small

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 are not legally responsible for injury to any participant in this program.

Parent/Guardian Signature:______________________________________________Date:__________________

mail application and check payable to Central Penn Mini Sticks to

Belinda Heltzel 104 Evergreen Circle

Dillsburg PA 17019

432-0108    bheltzel@gmail.com

Session 1: Dec 9^th, 16^th, Jan 6^th, 13^th and 20^th

                                      Session 2:  Jan 27^th, Feb 3^rd, 10^th, 17^th and 24^th

All games will be played at 5:00 at Twin Ponds West.  Play will be 7v7 on the “mega” field indoor turf.  Outdoor sticks and outdoor rules will apply with the exception of no corners.  Teams can play with or without a keeper.  One PIAA licensed official will be on each field.  Games will be 2 25 min halves with a 5 min half time.  Field size is approximately 50X30.  This league is for players 18 and older and is set up to allow a fun and competitive area to play field hockey.  There will not be a championship game or rankings among teams.  All players are asked to be respectful of the officials and other players.

The cost to join as a team is $270 per session… this fee will cover the cost of the turf and the fee for the officials

Team Registration Form           

Coach:_________________________________   Team Name:___________________________________ 

Coach Address:_________________________________________________________________________

Coach email:____________________________________Coach Phone:____________________________ 

_____ Session 1 (Application must be received by Dec 1^st)

_____ Session 2 (Application must be received by Jan 12^th)

All players must read the following waiver and sign below. 

I agree to participate in the Adult Open Field Hockey League at Twin Ponds West.  It is understood that Central Penn Mini Sticks, Twin Ponds, Belinda Heltzel and her staff are not legally responsible for injury to any participant in this program.

Player Name:_____________________________________________Signature:_______________________

Player Name:_____________________________________________ Signature:_______________________

Player Name:_____________________________________________ Signature:_______________________

Player Name:_____________________________________________ Signature:_______________________

Player Name:_____________________________________________ Signature:_______________________

Player Name:_____________________________________________ Signature:_______________________

Player Name:_____________________________________________ Signature:_______________________

Player Name:_____________________________________________ Signature:_______________________

Player Name:_____________________________________________ Signature:_______________________

Player Name:_____________________________________________ Signature:_______________________

mail check payable to Central Penn Mini Sticks to

Belinda Heltzel 104 Evergreen Circle, Dillsburg PA 17019

432-0108    bheltzel@gmail.com