Director: Jennifer Hershman, Brewster High School Varsity Field Coach & Brewster Central School District Physical and Health Education Teacher Sponsored by: Town of Southeast Recreation Department

Dates: June 14, 15, 16, 17 Rain Date: June 18 Location: BHS – Grass Field (inside the track)

Grades: Completing 6th, 7th, and 8th Time: 3:30-5:00pm

Grades: Completing 1st, 2nd, 3rd, 4th, and 5th Time: 5:00-6:30pm

Fee: $85 - Includes Shirt Payable to: TOWN OF SOUTHEAST

A clinic for all skill levels to learn, play, and have fun! During this exciting week, players will receive instruction in a positive learning environment to develop their abilities. Activities will increase every player's stick skills: dribbling, drives, passing, shooting and game strategies. Players can even try as the goalie.

Players will need to dress for outdoor play and bring: mouth guard, goggles, field , shin guards, cleats/, sunscreen, snacks & drinks.

------Please tear here and return with payment to the address below!------

ACTIVITIES REGISTRATION FORM PROGRAM:FIELD HOCKEY CLINIC______NAME:______MALE:______FEMALE:______SHIRT SIZE: Youth ____ or Adult ____ GRADE-SPRING 2021:______SCHOOL:______ADDRESS:______CITY:______STATE:______ZIP:______CELL PHONE#:______HOME PHONE#:______WORK PHONE#:______E-MAIL ADDRESS:______EMERGENCY CONTACT: ______PHONE#:______FEE (non-refundable) Payable to: TOWN OF SOUTHEAST: Check#______Cash: ______

______has my permission to participate in the Southeast Recreation program. I assume all risks and hazards incidental to such participation including transportation to and from activities. I do hereby waive, release, absolve, indemnify and agree to hold harmless the sponsors and coaches for any claim arising out of an injury to my child. I also understand that it is my responsibility to notify the instructor of any MEDICAL/PHYSICAL condition that could limit my child's participation or that requires special attention.

PARENT/GUARDIAN SIGNATURE:______DATE: ______Mail to or drop off at: Town of Southeast Recreation Department 1 Main Street/ Brewster, New York 10509 Phone:(845) 279-3915 Fax:(845) 279-3137 Web:www.southeast-ny.gov The Brewster Central School District neither sponsors nor endorses this event or organization. This information is distributed in line with the District’s policy to provide information regarding activities of general public interest which promote the education or other best interests of the students. Questions regarding this event or activity should be directed to the organization, not the District.