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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
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