Gator Elite Soccer Camp
Allegheny College
Soccer Camp Application Name
Gator Elite
Address City/State/Zip Home Phone ( Cell Phone (
Soccer Camp
) )
A
L
L
E
G
H
Ht.
E
Age
N
Y
Email:
June 15-17, 2012
Wt.
Years of Experience: School Team: Club Team:
For boys ages 15-18
Position:
Rising Sophomores,
This September: Grade
Age
Juniors, and Seniors
Address City/State/Zip Email
E
Name
L
Please send a Gator Elite Camp brochure to my friend at:
I
XL
T
L
E
M
C
S
A
Adult :
M
P
T-shirt size (circle one)
About the Directors
Medical Release/Waiver
Angelo Panzetta Head Coach, Men’s Soccer
North Coast Athletic Conference Champions 2004, Runners-up in 2005, 2006, and 2007 Overall record at Allegheny is 108-77-23 (eleven years) Ex-professional indoor soccer player (Harrisburg Heat and Baltimore Blast) “A” coaching license with the United States Soccer Federation (USSF)
Chris Keller Assistant Coach, Men’s Soccer
Completed fifth season at Allegheny as an assistant coach As a player at Riverside College, he broke the California Junior College assist record, while earning All-American status “B” coaching license with the USSF Member of Western PA ODP coaching staff
About the Camp Gator Elite Camp: June 15-17 Boys ages 15-18 Great opportunity to get a feel for Allegheny’s campus Both coaches will be at every session Specialized training for field players/goalkeepers geared toward more advanced players Two sessions Friday, three sessions Saturday, and one session Sunday Check-in starts 2:30 pm on Friday, June 15 Camp ends at noon on Sunday, June 17
I certify that my child has permission to participate in the camp at Allegheny College. He has been examined by a doctor in the last year and has been cleared to play the sport. I have health insurance. In the event of an injury, I wish to be contacted before treatment. If I cannot be contacted and my child needs emergency treatment, I authorize Allegheny College, the camp directors, or their agents to obtain reasonable emergency treatment. I absolve Allegheny College, the camp directors, and their agents of any liability or judgments that are a result of my child’s misconduct or negligence. I have read and understand this waiver.
Registration Cost: Gator Elite Camp - June 15-17 (Fri.-Sun.) $250 fee: includes room & board An information packet will be sent to individuals after their application is received. All campers receive two t-shirts.
Parent/Guardian
Payment
Signature
Checks payable to Allegheny College Soccer Camp will be accepted by mail with your reservation form by June 6. After June 6, please call or stop by the Wise Center on campus to register.
Date Home Phone
Send form and payment to: Soccer Camp Allegheny College—Box AC 520 North Main Street Meadville, PA 16335
Parent Cell Phone Insurance Co. Policy Number Secondary Emergency Contact Name Secondary Emergency Contact Phone Please advise of special health conditions (attach separate sheet)
For More Information Contact Phone: 814-332-5208 Angelo Panzetta Email: [email protected] Cut here
http://www.alleghenysports.com/
Soccer Camp Application Name
Gator Elite
Address City/State/Zip Home Phone ( Cell Phone (
Soccer Camp
) )
A
L
L
E
G
H
Ht.
E
Age
N
Y
Email:
June 15-17, 2012
Wt.
Years of Experience: School Team: Club Team:
For boys ages 15-18
Position:
Rising Sophomores,
This September: Grade
Age
Juniors, and Seniors
Address City/State/Zip Email
E
Name
L
Please send a Gator Elite Camp brochure to my friend at:
I
XL
T
L
E
M
C
S
A
Adult :
M
P
T-shirt size (circle one)
About the Directors
Medical Release/Waiver
Angelo Panzetta Head Coach, Men’s Soccer
North Coast Athletic Conference Champions 2004, Runners-up in 2005, 2006, and 2007 Overall record at Allegheny is 108-77-23 (eleven years) Ex-professional indoor soccer player (Harrisburg Heat and Baltimore Blast) “A” coaching license with the United States Soccer Federation (USSF)
Chris Keller Assistant Coach, Men’s Soccer
Completed fifth season at Allegheny as an assistant coach As a player at Riverside College, he broke the California Junior College assist record, while earning All-American status “B” coaching license with the USSF Member of Western PA ODP coaching staff
About the Camp Gator Elite Camp: June 15-17 Boys ages 15-18 Great opportunity to get a feel for Allegheny’s campus Both coaches will be at every session Specialized training for field players/goalkeepers geared toward more advanced players Two sessions Friday, three sessions Saturday, and one session Sunday Check-in starts 2:30 pm on Friday, June 15 Camp ends at noon on Sunday, June 17
I certify that my child has permission to participate in the camp at Allegheny College. He has been examined by a doctor in the last year and has been cleared to play the sport. I have health insurance. In the event of an injury, I wish to be contacted before treatment. If I cannot be contacted and my child needs emergency treatment, I authorize Allegheny College, the camp directors, or their agents to obtain reasonable emergency treatment. I absolve Allegheny College, the camp directors, and their agents of any liability or judgments that are a result of my child’s misconduct or negligence. I have read and understand this waiver.
Registration Cost: Gator Elite Camp - June 15-17 (Fri.-Sun.) $250 fee: includes room & board An information packet will be sent to individuals after their application is received. All campers receive two t-shirts.
Parent/Guardian
Payment
Signature
Checks payable to Allegheny College Soccer Camp will be accepted by mail with your reservation form by June 6. After June 6, please call or stop by the Wise Center on campus to register.
Date Home Phone
Send form and payment to: Soccer Camp Allegheny College—Box AC 520 North Main Street Meadville, PA 16335
Parent Cell Phone Insurance Co. Policy Number Secondary Emergency Contact Name Secondary Emergency Contact Phone Please advise of special health conditions (attach separate sheet)
For More Information Contact Phone: 814-332-5208 Angelo Panzetta Email: [email protected] Cut here
http://www.alleghenysports.com/
