Donation Form

* INSTRUCTIONS *

1. To register, please complete the attached waivers and submit your payment information.

This form allows for pay by check, debit card, or a credit card.

If you need assistance or have questions about signing up,
please contact [email protected].

Program Selection, Participant Information, Health, Insurance Details & Payment

To be filled out by Parent or Legal Guardian.
Please submit 1 form per participant. Thank you.

Your Relationship to Participant:

Participant’s First Name

Participant’s Last Name

Program Cost

Years of Field Hockey Experience

Will you need a stick provided by TPFH?

Grade Level

HEALTH HISTORY & HEALTH INSURANCE
If no conditions exist enter NONE. Please list and describe all physical or emotional limitation(s) your child may have, including but not limited to: Allergies, Vision, Asthma, Heart Murmur, High Blood Pressure, etc.

By clicking this box you confirm that all the information provided in the above PARTICIPANT HEALTH INFORMATION & PARENT RELEASE & WAIVER is accurate to the fullest extent.

I confirm that the participant is covered by Health Insurance and that the health information provided is accurate.

I confirm that all the information provided in the above PARTICIPANT HEALTH INFORMATION & PARENT RELEASE & WAIVER is accurate to the fullest extent.

Health Insurance Carrier

Insurance Policy Number

By clicking this box you confirm that you have read and agree to all terms in the above SDUHSD/TPHSF HOLD HARMLESS, RELEASE AND WAIVER OF LIABILITY.

I confirm that I have read and agree to the SDUHSD/TPHSF HOLD HARMLESS, RELEASE AND WAIVER OF LIABILITY.

By clicking this box you confirm the use of electronic communication as your form of consent.

By checking here, you agree to the use of your electronic consent in lieu of an original signature on paper. You have the right to request to sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged and no special hardware or software is required to view it. Make sure that we have your current email address. I agree via electronic consent to the terms of the PARTICIPANT HEALTH INFORMATION & PARENT RELEASE & WAIVER.

Parent/Guardian Information

Parent First Name

Parent Last Name

Additional Email

Address

Address 2

City

State/Province

Zip/Postal Code

Country

Cell/Emergncy Phone

Home Phone

Work Phone

Help Us Cover the Costs of the Credit Card Processing Fees

Simply leave "Yes!" checked below to ensure that 100% of your camp fees go to your team/booster.

Yes! I want to add the cost of credit card processing fees (3%) so that the full program fee of $0.00 will go to my team. The total payment amount will be $0.00.No. I am paying with ACH or, no I will not cover the processing costs.

Payment Information

Payment Options

Choose 'Bank Account' to Pay with a Check: Then simply click on the ? Help icon to see how to enter the routing and bank account numbers directly from one of your checks.

Credit Card Information

Card Holder Name

Card Account Number

Expiration Date

Security Code

Billing Address

Same As Above

Address

City

State/Province

Zip/Postal Code

Country

Privacy Policy: We take precautions to protect your information. We collect credit card or bank account information, names, addresses, and other data related to your transaction when you make a payment through the TPHS Foundation web site. We use this information to process your payment.

Terms/Conditions: By submitting your payment, you authorize us to charge your account for the amount specified in the Transaction Amount field. Account information for Recurring Pledges/Monthly Giving is encrypted and stored securely via SafeSave™ for automatic processing of your future payments. Notify us at anytime if you wish to discontinue your pledge.