Welcome to our May 2015 ID Clinic Description We are excited to offer our Identification and Skills camps in 2015. This small camp will be led by UNCW coaches and players. The staff may also include NCAA Div I coaches from the Southeast. The ID & Skills clinic is a great way for you and our coaching staff to evaluate and elevate your skill level. You will be challenged both mentally and physically in this competitive environment. In addition, these programs are a great way to prepare for your high school and club seasons. There will be Goalkeeper specific training sessions running at the same time as the field player sessions. * Lunch and accommodations for the clinic will be on your own. Instruction will include Technical Work Positional Play Finishing Defending Team Tactics Speed & Agility Session Recruiting information Session GK Specific training sessions Our May clinic is designed for high school age players who are serious about playing soccer in College. Our main focus for the day is to evaluate and identify college level players. While soccer showcases and tournaments are one way to be evaluated, attending our ID Clinics on the campus of UNCW is another great way to be seen. Seahawk Soccer May ID Clinic (Tentative Schedule) rd Sunday, May 3 , 2015 8:30 am 9:30 – 11:30 am 11:45 – 12:45 pm 2:00 – 4:00 pm Camp registration (Almkuist-Nixon Building) Training Session 1 Lunch / Rest Training Session 2 Registration Form May 3rd, 2015 Ages: 13 - H.S. Senior; Gender: Female Cost: $120 *This camp is restricted only by grade, gender and number of campers First Name ____________________________ Last Name ____________________________ Address ____________________________________________________________________ City ________________________ State ________ Zip ________Date of Birth_____________ Home Phone _________________________ Cell Phone _____________________________ Graduation Year ____________________ Club Team________________________________ High School Team_________________________ Parents Email ___________________________ Camper Email _________________________ Position (Circle): Def Mid Fwd GK T-Shirt Size (Circle) AS AM AL AXL Complete Registration Form and Camp Medical Waiver in entirety and return along with your $120 payment Forms can be submitted via: Email (please send forms as attachments): [email protected] Fax: (910)-962-3608 Attn: Women’s Soccer Mail: PCSA Seahawk Spring Clinic, UNCW PO Box 20019 Wilmington, NC 28407. Checks made payable to: Paul Cairney For other questions please call (910)-962-3932 Paul Cairney Soccer Academy LLC (PCSA, LLC) is open and accessible to individuals with disabilities while balancing the risk of physical injury to the individual and others. Participation in the camp by individuals with disabilities is subject to proper and ongoing review by PCSA, LLC. In order to assess and evaluate a request for an accommodation, PCSA, LLC must receive notice of the individuals desire to participate no later than 60 days prior to the commencement of the applicable camp. Inquiries may be directed to Paul Cairney at 910-962-3932 This camp is neither supported, controlled nor supervised by UNCW. Rather it is under the sole supervision and control of PCSA LLC Camper _____________________________________Birth Date (Please print full legal name) Sport Women’s Soccer Session Date: May ID Clinic, May 3rd, 2015 Release and Medical Authorization The release and treatment authorization must be signed by a parent or guardian if student is under 18 years old. Students who are 18 years old or will become 18 years old before the end of the program must also sign. In order for students to participate in camp activities we must have this form. Otherwise parent or guardian must be contacted prior to participation. Parent’s/Guardian’s Authorization This is to certify that has been examined by a physician within the past year, and that she was found to be physically able to participate in vigorous physical activity and competitive athletic sports. Date of last tetanus immunization Allergies Drug Sensitivities Other Medical Problems/Current Medications What accommodations should be made to insure proper administration and storing of the medication? Is an identification band or card carried to alert others to the allergy(ies), medical conditions or medication use? Y N Signed X Parent/Guardian Release of Liability and Medical and Surgical Authorization In consideration of being permitted to participate in the Paul Cairney Soccer Academy at UNCW, I hereby assume the risks of personal injury that may result from program activities. I am knowledgeable about the sport, have previously participated in the sport, and am aware of the potential for injury while participating. As a participant and/or as a parent or guardian, I do hereby release Paul Cairney Soccer Academy LLC, the North Carolina State Board of Regents, The University of North Carolina at Wilmington, the Sports Camps and their officers, employees and agents, from all liability for personal injury or property damage which result from causes beyond the control of, and without the fault or negligence of it’s employees, agents or officers. As a parent or guardian of the above named child, I do hereby release the Paul Cairney Soccer Academy LLC, the North Carolina State Board of Regents, the University of North Carolina at Wilmington, and any and all volunteers, employees, officers, and agents, of the above named entities, from any and all liability for personal injury which may occur to my child during the visit to the beach and/or traveling to and from the UNC Wilmington campus and the beach. (sr camp only)I hereby authorize and give my consent to the health care providers to perform upon or administer to my above named child any reasonable, necessary surgical or medical treatment. I also give permission to administer whatever anesthetic may be necessary or advisable during the medical or surgical procedures. This authorization is intended to cover emergency treatment, immunizations, injections, and minor operations and procedures. In the case of psychiatric and/or psychological emergencies involving psychological treatment, parental authorization for treatment beyond that responsive to the emergency will be requested. This permission is good only while the student is attending the Paul Cairney Soccer Academy at the University of North Carolina at Wilmington and only until the student has attained his/her eighteenth birthday. X Parent’s/Guardian’s Signature Date X Student’s Signature Date Name Parent/Guardian Print or Type Address City State Home Phone Policy No. Date Insurance Company Zip Insurance Co. Address Work Phone _____________________________________________ Policy Holder ________
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