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
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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
________