2017 Wyoming Valley West Field Hockey

Mayhem
7x7 Field Hockey Tournament

Date: Saturday, May 20, 2017 (Rain Date Sunday May 21, 2017) Time: 8:00 am

Location: WVW High School Stadium, Pierce and Gates Streets, Kingston, Pa 18704
Format: Each team is guaranteed 5 games. Playoffs for top finishing teams
Pools: Please note High School or Junior High on registration form
Teams:
Teams may have any number of players on the team roster. Field Hockey programs
may enter multiple teams in the tournament. Teams may supplement rosters with
rising 8th graders if desired.
Entry Fees:
Early Entry Fee: $225.00 per team if received before March 18, 2017 (Registration
and payment MUST be post marked by March 15, 2017 in order to receive early
fee)
After March 18th: $250.00
Checks made payable to: Wyoming Valley West Field Hockey Booster Club
Send Payment and Registration to:
Kristine Evans (Event Co-Chair)
377 Slocum Street
Swoyersville, Pa 18704
Registration Deadline: April 18, 2017. Teams will be accepted on a first come first
serve basis, RSVP via email to kristinemevans@gmail.com. Payment and Registration
MUST be postmarked by April 18, 2017.
Upon receiving your registration and payment, we will email waiver and player roster
forms. Please return, via email, your team rosters. Final tournament schedule will be
emailed prior to the event.
Waivers: Coaches please, bring completed waivers and insurance information on game
day when you check in your team.
Insurance: WVW School District or WVW Field Hockey Booster Club are not responsible
for injuries or accidents as a result of competition. Each participant must carry her own
personal medical insurance policy. It will be each teams responsibility to ensure player
coverage.
Concessions will be available throughout the day.
Questions: Please contact Kristine Evans, via email, at kristinemevans@gmail.com
Tournament updates will be posted on our website: www.wvwfieldhockey.org

2017 Wyoming Valley West Field Hockey

Mayhem
7x7 Field Hockey Tournament
Registration Form
Saturday May 20, 2017 (Rain Date: Sunday May 21,
2017)
Mail Registration Form and Payment to:
Kristine Evans
377 Slocum Street
Swoyersville, Pa 18704
Please complete a separate registration form for each team
you register.

Team Name:
________________________________________________
Team Color:
_________________________________________________
Team Coach:
________________________________________________
Contact Name:
_______________________________________________
Phone Number: ____________-
__________________________________
Contact Email:
_______________________________________________
Please circle one: High School Junior High

Booster Club Use Only:

Date received: ___________
Payment: _______________
Received by: ____________
THIS FORM MUST BE COMPLETED BY EVERY
PLAYER/PARENT
2017 Wyoming Valley West Field Hockey
Mayhem
7x7 Field Hockey Tournament
Player Name: ______________________________________ Email: _____________________________________
Address __________________________________________ City: ___________________ State: _____ Zip:
________
Home Phone: (____) ___________________________ Date of Birth: _________________ Grade:
_______________
In consideration of being allowed to participate in any way in the WYOMING VALLEY WEST FIELD
HOCKEY MAYHEM TOURNAMENT
I, the Parent/Guardian of the undersigned, acknowledge, appreciate, and agree that:
1. The risk of injury from the activities involved in this program is significant, including the
potential of permanent paralysis and death, and while particular rules, equipment, and
personal discipline may reduce this risk, the risk of personal injury does exist; and
2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown of my
participation in the event, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or
others, and assume full responsibility for my participation; and,
3. I willingly agree to comply with the stated and customary terms and conditions for
participation in the league. If however, I observe any unusual significant hazard during my
presence or participation, I will remove myself from participation and bring such to the
attention of the nearest official immediately; and
4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin,
HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS Wyoming Valley West School District
and the WVWFH Booster Club, their officers, officials, agents, and/or employees, other
participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and
 lessors of premises used to conduct the event (Releases), WITH RESPECT TO ANY AND
ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER
ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent
permitted by law.
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT,
FULLY UNDERSTAND AND ITS TERMS, UNDERSTAN THAT I HAVE GIVEN UP
SUBSTANCIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT
ANY INDUCEMENT. FURTHERMORE I VERIFY THAT I HAVE PERSONAL INSURANCE.
(please include copy of insurance)
This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent
and agree to his/her release as provided above of all the Releasees, and for myself, my heirs,
assigns, and next of kin, I release and agree to indemnify and hold harmless and Releasees from
any and all liabilities incident to my minor childs involvement or participation in these programs
as provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, to the fullest
extent permitted by law.

X_______________________________________________________________
PARENT/GUARDIAN PRINTED NAME (PLAYER IF OVER 18 YEARS OF AGE) DATE
SIGNED: ______________
X_______________________________________________________________
PARENT/GUARDIAN SIGNATURE (PLAYER IF OVER 18 YEARS OF AGE)