Chattanooga Player Development Soccer Academy
INSURANCE COMPANY NAME ––––––––––––––––––––––––––––– POLICY NUMBER:
Camp Information
–––––––––––––––––––––––––––––––
CONFIRMATION
Emergency Contact Information Name: ________________________________________ Relationship____________________________________ Phone_________________________________________ Family Doctor__________________________________ Phone_________________________________________ Player Known Allergies: ______________________________________________ Asthma? _____________ Diabetes? ________________ Current medications: ______________________________________________
I, the undersigned, hereby certify that I am the parent or legal guardian of the above camper. I hereby give permission for the Camp Staff to seek during the period of the camp appropriate medical attention for the camper and for medical attention to be given in the event of accident, injury, or illness. I will be responsible for any and all costs of medical attention and treatment. I the undersigned for myself and as guardian of the above camper understand that soccer is an active, physical sport, and that injuries can take place during play. I also understand that, as with any sport, an injury can occur, and I hereby acknowledge that my child is physically fit and mentally capable of participating in soccer and all camp activities. I represent that I have sought the opinion of my child’s pediatrician, and he/she concurs that the above camper is fully capable of safely engaging in these activities. I the undersigned for myself, my heirs, executors and administrators, waive, release and forever discharge John Millard, Chattanooga Player Development Academy and its staff, officers, agents, employees, representatives, successors and assign of and from all rights and claims for damages, injury, or loss to person or property which may be sustained or occur during participation in camp activities or while at camp, whether or not damages, injury, or loss is due to negligence.
_____________________________________ Parent or Guardian Signature
Date
Once your application and $50 deposit is received, confirmation of your enrollment into the Chattanooga Player Development Academy is sent via email. If no email address is available, your cleared check will serve as confirmation.
Chattanooga Player Development Soccer Academy
All campers receive an academy shirt and four days of professional instruction. Camp soccer balls are available for a $10 charge MEALS Full-Day campers should bring their own lunch each day. Water will be provided throughout the day. ENROLLMENT Return this form along with a $50 non-refundable deposit. Enrollment is limited and early registration is encouraged. Teams are accepted and accommodations will be made to keep teams together during the day session.
June 17-20, 2013 Redoubt Soccer Complex
QUESTIONS For additional information please contact: JOHN MILLARD [email protected] 423-443-8852
www.chattanoogapda.com
Application Half-day Individual Camp: Recommended for U9 and below
2013 Chattanooga Player Development Academy Academy Director: John Millard Tennessee Olympic Development Program State Staff East Hamilton Men’s and Women’s Head Coach NSCAA Advanced National Diploma (USSF B) NSCAA Goal Keeping Diploma CAMP PHILOSOPHY: What sets the Chattanooga Player Development Academy apart is the philosophy behind the approach. All staff members and instructors – current college coaches, current and former college players, Chattanooga FC players and staff, and TN Olympic Development Program coaches are not only players with the ability to demonstrate but are also first and foremost teachers of the game committed to player development. Through an educational approach, instructors are well versed in all technical and tactical aspects of the game and also understand the methodology of how to teach effectively and efficiently. Academy Director John Millard has established a reputation as one of the finest teachers of the game in the state. His love of teaching and emphasis on player development has propelled the Chattanooga PDA. Within the academy, his instructors teach the fundamentals of the game in a structured environment with a focus on developing the players for the future. Each player gets individualized attention. Key to the academy’s methodology is teaching a progressive age-appropriate and age-specific curriculum designed to motivate players and prepare them for the future. All players receive consistent and innovative
approach with emphasis on learning through enjoyment while developing their skills and a passion for the game. Our emphasis is on players receiving as many touches on the ball as possible and providing plenty of opportunities to express their individual creativity and score goals. Through a small-sided games approach (4v4, 8v8), our academy staff provides soccer-related objectives that cover all aspects of the game. The four components of the game – fitness, tactics, technique, and psychology – will be covered every day during an academy session. The small-sided games approach is a proven mechanism to create optimum learning environment that is fun and challenging to all players. Name__________________________________________ Address________________________________________ City/ST/Zip_____________________________________ Home Phone_____________________________________ Father’s Name___________________________________ Work/Cell Phone_________________________________ Mother’s Name__________________________________ Work/Cell Phone_________________________________ Email__________________________________________ Age at camp_____________________________________ To reserve your spot, this application and a fifty-dollar ($50) non-refundable deposit for each camper must be mailed to: John Millard, 201 Raintree Lane, Chattanooga, TN, 37421
Full-day Individual Camp: Recommended for U10 and up
Individual Academy Full Day (9am-3pm) ___$150* Half Day (9am-12pm) ___ $100 Advanced Team Academy 6:00 – 8:00pm _____ $125 Must have ten (10) players School Name:___________________
Keeper Academy Full Day (9-3) ___$175 Half Day (9-12) ___ $100 *125 for Redoubt or CFC players registering before May 12 Current Playing Level: ___ REC
___Select
____School
Shirt Size (circle one): YS YM YL AS AM AL AXL * Ball Size (circle one):
4
5
* There is a $10 charge for a camp soccer ball
Camp Information
–––––––––––––––––––––––––––––––
CONFIRMATION
Emergency Contact Information Name: ________________________________________ Relationship____________________________________ Phone_________________________________________ Family Doctor__________________________________ Phone_________________________________________ Player Known Allergies: ______________________________________________ Asthma? _____________ Diabetes? ________________ Current medications: ______________________________________________
I, the undersigned, hereby certify that I am the parent or legal guardian of the above camper. I hereby give permission for the Camp Staff to seek during the period of the camp appropriate medical attention for the camper and for medical attention to be given in the event of accident, injury, or illness. I will be responsible for any and all costs of medical attention and treatment. I the undersigned for myself and as guardian of the above camper understand that soccer is an active, physical sport, and that injuries can take place during play. I also understand that, as with any sport, an injury can occur, and I hereby acknowledge that my child is physically fit and mentally capable of participating in soccer and all camp activities. I represent that I have sought the opinion of my child’s pediatrician, and he/she concurs that the above camper is fully capable of safely engaging in these activities. I the undersigned for myself, my heirs, executors and administrators, waive, release and forever discharge John Millard, Chattanooga Player Development Academy and its staff, officers, agents, employees, representatives, successors and assign of and from all rights and claims for damages, injury, or loss to person or property which may be sustained or occur during participation in camp activities or while at camp, whether or not damages, injury, or loss is due to negligence.
_____________________________________ Parent or Guardian Signature
Date
Once your application and $50 deposit is received, confirmation of your enrollment into the Chattanooga Player Development Academy is sent via email. If no email address is available, your cleared check will serve as confirmation.
Chattanooga Player Development Soccer Academy
All campers receive an academy shirt and four days of professional instruction. Camp soccer balls are available for a $10 charge MEALS Full-Day campers should bring their own lunch each day. Water will be provided throughout the day. ENROLLMENT Return this form along with a $50 non-refundable deposit. Enrollment is limited and early registration is encouraged. Teams are accepted and accommodations will be made to keep teams together during the day session.
June 17-20, 2013 Redoubt Soccer Complex
QUESTIONS For additional information please contact: JOHN MILLARD [email protected] 423-443-8852
www.chattanoogapda.com
Application Half-day Individual Camp: Recommended for U9 and below
2013 Chattanooga Player Development Academy Academy Director: John Millard Tennessee Olympic Development Program State Staff East Hamilton Men’s and Women’s Head Coach NSCAA Advanced National Diploma (USSF B) NSCAA Goal Keeping Diploma CAMP PHILOSOPHY: What sets the Chattanooga Player Development Academy apart is the philosophy behind the approach. All staff members and instructors – current college coaches, current and former college players, Chattanooga FC players and staff, and TN Olympic Development Program coaches are not only players with the ability to demonstrate but are also first and foremost teachers of the game committed to player development. Through an educational approach, instructors are well versed in all technical and tactical aspects of the game and also understand the methodology of how to teach effectively and efficiently. Academy Director John Millard has established a reputation as one of the finest teachers of the game in the state. His love of teaching and emphasis on player development has propelled the Chattanooga PDA. Within the academy, his instructors teach the fundamentals of the game in a structured environment with a focus on developing the players for the future. Each player gets individualized attention. Key to the academy’s methodology is teaching a progressive age-appropriate and age-specific curriculum designed to motivate players and prepare them for the future. All players receive consistent and innovative
approach with emphasis on learning through enjoyment while developing their skills and a passion for the game. Our emphasis is on players receiving as many touches on the ball as possible and providing plenty of opportunities to express their individual creativity and score goals. Through a small-sided games approach (4v4, 8v8), our academy staff provides soccer-related objectives that cover all aspects of the game. The four components of the game – fitness, tactics, technique, and psychology – will be covered every day during an academy session. The small-sided games approach is a proven mechanism to create optimum learning environment that is fun and challenging to all players. Name__________________________________________ Address________________________________________ City/ST/Zip_____________________________________ Home Phone_____________________________________ Father’s Name___________________________________ Work/Cell Phone_________________________________ Mother’s Name__________________________________ Work/Cell Phone_________________________________ Email__________________________________________ Age at camp_____________________________________ To reserve your spot, this application and a fifty-dollar ($50) non-refundable deposit for each camper must be mailed to: John Millard, 201 Raintree Lane, Chattanooga, TN, 37421
Full-day Individual Camp: Recommended for U10 and up
Individual Academy Full Day (9am-3pm) ___$150* Half Day (9am-12pm) ___ $100 Advanced Team Academy 6:00 – 8:00pm _____ $125 Must have ten (10) players School Name:___________________
Keeper Academy Full Day (9-3) ___$175 Half Day (9-12) ___ $100 *125 for Redoubt or CFC players registering before May 12 Current Playing Level: ___ REC
___Select
____School
Shirt Size (circle one): YS YM YL AS AM AL AXL * Ball Size (circle one):
4
5
* There is a $10 charge for a camp soccer ball
