Registration

BLACKHEATH FH CLUB REGISTRATION FORM

This program is every Thursday for 16 weeks. Where: Empire Sports & Training, 525 Riverside Avenue, Lyndhurst, NJ

March-April 2022
3/3, 3/10, 3/17, 3/24
4/7, 4/14, 4/21, 4/28.
May-June 2022
5/5, 5/12, 5/19, 5/26
6/2, 6/9, 6/16, 6/23.
Time: 7pm-8pm.

Cost: $550 for all 16 sessions
$280 for either 8 week session. Choose March/April or May/June.
**$30 membership fee required for all new players.
***Take advantage of a 10% saving by signing up for 16 weeks of classes by February 10th, 2022. Cost reduced to $495.
Deadline to register: February 25th.

Payment options:
1) Via Venmo to: @blackheathfh
2) Via PayPal to: Feridon230@yahoo.com
Make sure to choose options: “send to a friend” as they charging fee for both sides.
3) Check or Cash.

Student Name*

State* City*

Address*

Phone*

Birth Date Age

Alt.Phone* E-Mail*

Father Name* Cell Phone*

Mother Name* Cell Phone*

Family Doctor* Phone*

Doctor's Office*

Medical conditions, if any

Emergency Contact (other than yourself)

Enrollment date

Days and Times of the class

You must complete registration forms.
Please fill out registration form to hold the space for your child. To complete your registration, please mail all registration paperwork and check to:
Blackheath Field Hockey Club
1 Jennifer Way
Fairfield, NJ 07004

Release and Waiver form
 Player Code of Conduct
Parents Code of Conduct & Permission from 
Team Policies and Competition rules
No athlete will be attend practice without complete registration paperwork and payment.
No exceptions.