2016 Summer ID Clinic
WHEN:
SATURDAY, JUNE 18th, 2016 (Rain or Shine)
TIME:
10:00am – 4:00pm (Registration/Check-In from 9:15am – 9:45am)
WHERE:
Fairleigh Dickinson University – Florham Campus (Robert T. Shields Field/Stadium)
WHO:
Girls, Ages 15 – 18
COST:
$125.00 per player (Please make checks payable to Kristin Giotta c/o FDU Women’s Soccer) *Registration Deadline: June 10th, 2016* ID CLINIC BREAKDOWN 10:00am – 12:00pm: Technical Work & Small-Sided Games 12:15pm – 1:45pm: Lunch (provided) and Q & A with Current FDU Women’s Soccer Players 2:00pm – 4:00pm: Full-Sided Games *Players should bring a ball, shin guards, cleats, change of clothes, rain gear & sneakers.* *Water/ice, lunch & a t-shirt will be provided for each player!* QUESTIONS??? PLEASE CONTACT HEAD COACH, KRISTIN GIOTTA: [email protected] or 973-443-8943
PLEASE TEAR OFF THE APPLICATION FORM BELOW AND MAIL IN THE FOLLOWING 1) APPLICATION FORM; 2) PAYMENT; 3) LIABILITY WAIVER
FAIRLEIGH DICKINSON UNIVERSITY WOMEN’S SOCCER – 2016 SUMMER ID CLINIC PLAYER APPLICATION PLAYER NAME: ______________________________________________________ AGE: _________ YEAR (circle):
FR.
SO.
JR.
SR.
HOME ADDRESS: ______________________________________________________ CITY: ______________________ ST: _______ ZIP: __________ HOME PHONE: _________________________________________________ CELL PHONE: ____________________________________________________ POSITION(S): _____________________________________________ CLUB TEAM: _________________________________________________________ HIGH SCHOOL: ________________________________________________ EMAIL: ____________________________________________________________ Please mail application, payment & waiver by June 10th, 2016 to: Kristin Giotta, Head Women’s Soccer Coach Fairleigh Dickinson University – Florham Campus 285 Madison Avenue, Madison, NJ 07940
Fairleigh Dickinson University – Florham Campus Driving Directions GPS ADDRESSES 285 Madison Avenue Madison, NJ 07940 (If traveling Route 287) 175 Park Avenue Florham Park, NJ 07940 (If traveling Garden State Parkway, Route 78, Route 24) From Northeast: Take I-287 across the Tappan Zee Bridge to Exit 37 (NJ 24 East). Follow NJ 24 East to Exit 2A (NJ 510 West). At first light (Park Avenue), make a left. The entrance to FDU is four lights down on the right-hand side. This is the PARK AVENUE GATE. From West on I-80;Northern PA: Exit onto I-287 South to Exit 37 (NJ 24 East). Follow NJ 24 East to Exit 2A (NJ 510 West). At first light (Park Avenue), make a left. The entrance to FDU is four lights down on the righthand side. This is the PARK AVENUE GATE. From South: Take NJ Turnpike to Exit 10, I-287 North to Exit 35. At the end of exit, turn left at light. Make quick right; go one block and make another right onto Madison Avenue (Route 124 East). The entrance to campus is approximately 2.5 miles on the left, shortly after passing the Madison Hotel. This is the MADISON AVENUE GATE. From Newark Area: I-78 West. Follow Route 24 West to Exit 2A (NJ510 West). At first light, turn left. The entrance to the FDU campus is four lights down on the right hand side. This is the PARK AVENUE GATE. From New York City (approx. 25 miles): From Lincoln Tunnel, continue to I-95 (New Jersey Turnpike) south to Exit 15W - I-280. Follow I-280 West to 80 West to I-287 South to Exit 37 (NJ 24 East). Follow NJ 24 East to Exit 2A (NJ 510 West). At first light (Park Avenue), make a left. The entrance to FDU is four lights down on the right-hand side. This is the PARK AVENUE GATE. From Central/Southern Pennsylvania: Take I-78 East to I-287 North to Exit 35. At the end of exit, turn left at light. Make a quick right; go one block and make another right onto Madison Avenue (Route 124 East). The entrance to campus is approximately 2.5 miles on the left, shortly after passing the Madison Hotel. This is the MADISON AVENUE GATE. *ROBERT T. SHIELDS FIELD/STADIUM* Park Avenue Gate: Proceed ALL THE WAY up the hill to the information booth. Turn right at booth. Follow road around bend. Field is straight ahead, just past Ferguson Recreation Center. Please park in the lot across from the Ferguson Recreation Center.
Madison Avenue Gate: Proceed through the gate, over the small bridge and under the railroad overpass. Make a left at the stop sign, just past the information booth. Field is on your immediate left. Please park in the lot across from the Ferguson Recreation Center which is directly across from the stadium.
NAME OF PARTICIPANT: ____________________________________________________________ NAME OF PARENT: _________________________________________________________________ CERTIFICATION OF PHYSICAL FITNESS TO PARTICIPATE: 1. I understand that there is a risk in participating in any sport, a risk of injury, including but not limited to serious permanent injury, paralysis, and death. To minimize the risk of injury, I agree to tell my child to obey all safety rules and to report fully any problems related to her physical condition to FDU Women’s Soccer coaches as so as the problem begins. 2. By signing below, I certify the following: • That my child is not currently under the care of a physician for an injury or illness that would prevent her safe participation in this clinic. • That my child is not currently being treated for or recovering from an orthopedic injury that would prevent her safe participation in this clinic. • That my child has no history of fainting or other problems related to strenuous exercise. • That my child is in good health and there is no reason she cannot safely participate in strenuous physical activity. Parent/Guardian (Signature): _________________________________________________________ Date: ____________________________ CONSENTS: 1. By my signature below, I hereby give permission for FDU Women’s Soccer staff to obtain medical treatment for my child, ___________________, in the event of accident or illness during her time at the clinic on Saturday, June 18th, 2016. Date: ____________________________ RELEASE: 1. I do hereby agree that I am and shall be responsible for all costs associated with any injury or loss that may be sustained by my child as a result of her participation in the FDU Women’s Soccer Clinic. I also certify that I have health insurance that provides adequate coverage for injuries or illness my child may sustain while participating in the FDU Women’s Soccer Clinic. 2. By my signature below, I also agree to release and promise not to sue FDU Women’s Soccer staff or Fairleigh Dickinson University for any damages, loss, injury or death arising from my child's participation in the FDU Women’s Soccer Clinic. Parent/Guardian (Printed Name): ____________________________________________________ Parent/Guardian (Signature): ________________________________________________________ Date: _____________________________
SATURDAY, JUNE 18th, 2016 (Rain or Shine)
TIME:
10:00am – 4:00pm (Registration/Check-In from 9:15am – 9:45am)
WHERE:
Fairleigh Dickinson University – Florham Campus (Robert T. Shields Field/Stadium)
WHO:
Girls, Ages 15 – 18
COST:
$125.00 per player (Please make checks payable to Kristin Giotta c/o FDU Women’s Soccer) *Registration Deadline: June 10th, 2016* ID CLINIC BREAKDOWN 10:00am – 12:00pm: Technical Work & Small-Sided Games 12:15pm – 1:45pm: Lunch (provided) and Q & A with Current FDU Women’s Soccer Players 2:00pm – 4:00pm: Full-Sided Games *Players should bring a ball, shin guards, cleats, change of clothes, rain gear & sneakers.* *Water/ice, lunch & a t-shirt will be provided for each player!* QUESTIONS??? PLEASE CONTACT HEAD COACH, KRISTIN GIOTTA: [email protected] or 973-443-8943
PLEASE TEAR OFF THE APPLICATION FORM BELOW AND MAIL IN THE FOLLOWING 1) APPLICATION FORM; 2) PAYMENT; 3) LIABILITY WAIVER
FAIRLEIGH DICKINSON UNIVERSITY WOMEN’S SOCCER – 2016 SUMMER ID CLINIC PLAYER APPLICATION PLAYER NAME: ______________________________________________________ AGE: _________ YEAR (circle):
FR.
SO.
JR.
SR.
HOME ADDRESS: ______________________________________________________ CITY: ______________________ ST: _______ ZIP: __________ HOME PHONE: _________________________________________________ CELL PHONE: ____________________________________________________ POSITION(S): _____________________________________________ CLUB TEAM: _________________________________________________________ HIGH SCHOOL: ________________________________________________ EMAIL: ____________________________________________________________ Please mail application, payment & waiver by June 10th, 2016 to: Kristin Giotta, Head Women’s Soccer Coach Fairleigh Dickinson University – Florham Campus 285 Madison Avenue, Madison, NJ 07940
Fairleigh Dickinson University – Florham Campus Driving Directions GPS ADDRESSES 285 Madison Avenue Madison, NJ 07940 (If traveling Route 287) 175 Park Avenue Florham Park, NJ 07940 (If traveling Garden State Parkway, Route 78, Route 24) From Northeast: Take I-287 across the Tappan Zee Bridge to Exit 37 (NJ 24 East). Follow NJ 24 East to Exit 2A (NJ 510 West). At first light (Park Avenue), make a left. The entrance to FDU is four lights down on the right-hand side. This is the PARK AVENUE GATE. From West on I-80;Northern PA: Exit onto I-287 South to Exit 37 (NJ 24 East). Follow NJ 24 East to Exit 2A (NJ 510 West). At first light (Park Avenue), make a left. The entrance to FDU is four lights down on the righthand side. This is the PARK AVENUE GATE. From South: Take NJ Turnpike to Exit 10, I-287 North to Exit 35. At the end of exit, turn left at light. Make quick right; go one block and make another right onto Madison Avenue (Route 124 East). The entrance to campus is approximately 2.5 miles on the left, shortly after passing the Madison Hotel. This is the MADISON AVENUE GATE. From Newark Area: I-78 West. Follow Route 24 West to Exit 2A (NJ510 West). At first light, turn left. The entrance to the FDU campus is four lights down on the right hand side. This is the PARK AVENUE GATE. From New York City (approx. 25 miles): From Lincoln Tunnel, continue to I-95 (New Jersey Turnpike) south to Exit 15W - I-280. Follow I-280 West to 80 West to I-287 South to Exit 37 (NJ 24 East). Follow NJ 24 East to Exit 2A (NJ 510 West). At first light (Park Avenue), make a left. The entrance to FDU is four lights down on the right-hand side. This is the PARK AVENUE GATE. From Central/Southern Pennsylvania: Take I-78 East to I-287 North to Exit 35. At the end of exit, turn left at light. Make a quick right; go one block and make another right onto Madison Avenue (Route 124 East). The entrance to campus is approximately 2.5 miles on the left, shortly after passing the Madison Hotel. This is the MADISON AVENUE GATE. *ROBERT T. SHIELDS FIELD/STADIUM* Park Avenue Gate: Proceed ALL THE WAY up the hill to the information booth. Turn right at booth. Follow road around bend. Field is straight ahead, just past Ferguson Recreation Center. Please park in the lot across from the Ferguson Recreation Center.
Madison Avenue Gate: Proceed through the gate, over the small bridge and under the railroad overpass. Make a left at the stop sign, just past the information booth. Field is on your immediate left. Please park in the lot across from the Ferguson Recreation Center which is directly across from the stadium.
NAME OF PARTICIPANT: ____________________________________________________________ NAME OF PARENT: _________________________________________________________________ CERTIFICATION OF PHYSICAL FITNESS TO PARTICIPATE: 1. I understand that there is a risk in participating in any sport, a risk of injury, including but not limited to serious permanent injury, paralysis, and death. To minimize the risk of injury, I agree to tell my child to obey all safety rules and to report fully any problems related to her physical condition to FDU Women’s Soccer coaches as so as the problem begins. 2. By signing below, I certify the following: • That my child is not currently under the care of a physician for an injury or illness that would prevent her safe participation in this clinic. • That my child is not currently being treated for or recovering from an orthopedic injury that would prevent her safe participation in this clinic. • That my child has no history of fainting or other problems related to strenuous exercise. • That my child is in good health and there is no reason she cannot safely participate in strenuous physical activity. Parent/Guardian (Signature): _________________________________________________________ Date: ____________________________ CONSENTS: 1. By my signature below, I hereby give permission for FDU Women’s Soccer staff to obtain medical treatment for my child, ___________________, in the event of accident or illness during her time at the clinic on Saturday, June 18th, 2016. Date: ____________________________ RELEASE: 1. I do hereby agree that I am and shall be responsible for all costs associated with any injury or loss that may be sustained by my child as a result of her participation in the FDU Women’s Soccer Clinic. I also certify that I have health insurance that provides adequate coverage for injuries or illness my child may sustain while participating in the FDU Women’s Soccer Clinic. 2. By my signature below, I also agree to release and promise not to sue FDU Women’s Soccer staff or Fairleigh Dickinson University for any damages, loss, injury or death arising from my child's participation in the FDU Women’s Soccer Clinic. Parent/Guardian (Printed Name): ____________________________________________________ Parent/Guardian (Signature): ________________________________________________________ Date: _____________________________
