To register go to AWS
CONTACT INFORMATION
~Coach Alex López~ PBHS Varsity Soccer Coach Indialantic Youth Soccer Kicks4Tots Program Director FYSA License
Email
Objectives Players will be grouped according to their age and ability so they can receive technical and tactical instruction. These camps are designed for both field players and goalkeepers.
Technical
Players will receive skill training from elite level staff coaches during the camp sessions. Our coaches use a variety of fun activities and games to improve footwork, first touch, passing, trapping, heading, shooting, and goalkeeping
Tactical Players will learn many defensive shapes and attacking schemes from coaches who have played all around the world. Everyday at least one hour will be dedicated for small-sided games to work on techniques and strategies under high pressure. This will allow players to use their tactical knowledge, skills and athleticism in full sided games with a team focus and competitive
THE BALL IS THE TEACHER IMPROVE YOUR GAME NOW!!! edge.
[email protected]
Phone
(321) 693-4684 ~Coach Alberto Araujo~ US Soccer National Youth License CBHS Girls Varsity & JV Goal Keeper Coach NSCAA Goalkeeper Level III National License
Email [email protected]
Phone
(321) 427-9636
To register go to www.IYSA.net
INDIALANTIC SUMMER SOCCER CAMP
LOCATION 2000 Hawk Haven Dr, Indialantic, FL 32903 321-693-4684 Camp Dates & Times June 16th-19th June 23rd-26th July 7th-10th Ages 3-4 from 9:00am to 11:00am Ages 5 and up from 9:00am to 2:00pm -Camp PricesCampers 5 and up: $120 (Kicks For Tots) $60 5 players Team Rate: $110 Camp Includes: Lunch, Camp T-shirt Beach Soccer Fun Day !! More touches of the ball makes better players.
ASSUMPTION OF RISK AND RELEASE I,___________________________ parent/legal guardian of ____________________________, (name) (camper name) acknowledge that as a Parent/legal Guardian. I authorize my child to participate in the soccer camp which is being organized by Sport-Specific Training Inc. I recognize that there are direct and inherent risks and hazards associated with this camp, making it a dangerous Activity with the potential to cause injury or loss of limb or life. With full knowledge of these facts and circumstances related to this camp, I knowingly and voluntarily have elected and agreed to allow my child to undertake this Activity, and I agree to assume all responsibility and risk from my child participation in this camp, including, without limitation, all risk of injury or loss of limb or life, property damage and injury to others. I represent to officials of all organizers of the event that I have adequate health insurance necessary to provide for and pay any medical costs that may directly or indirectly result from my child(s) participation in this camp, and I hereby release IYSA, Indialantic Youth Soccer Association and Brevard County Public Parks from any liability for such costs. I further represent to IYSA, BCPP, and Event organizers that my child has no healthrelated reason, condition or problem which would preclude or restrict him/her participation in this camp. I understand that IYSA willingness to allow my child to participate in this Activity stems from these representations. As stated in the Emergency Contract and Medical Information Form below, I authorize IYSA and any of its officers, agents and employees to secure any and all necessary emergency medical treatment for my child in the event he or she suffer injury or illness while participating in this camp. As a parent or legal guardian, I state that I am freely agreeing to assume and take on for myself all of the risks and responsibilities in any way associated with this camp. In consideration of IYSA providing my child the opportunity to participate in this camp; 1. I release IYSA and its trustees, officers, employees and agents from any and all liability, claims and actions that may arise from injury or harm to my child, from his/her death or from damage to his/her property in connection with this camp, and I understand that this Release covers liability, claims and actions caused entirely or in part by any acts or failure to act of IYSA or its trustees, officers, employees or agents, including, without limitation, negligence, mistake or failure to supervise by IYSA 2. I agree to indemnify, defend and hold harmless IYSA and its trustees, officers, employees and agents from any liability, claim or action to a third party caused by child act or omission. I recognize that this Release means I am giving up, among other things, my rights to sue IYSA and its trustees, officers, employees and agents for injuries, damages, or losses that my child may incur. I also understand that this Release binds my heirs, executors, administrators, and assigns, as well as me. I acknowledge that I have had the chance to seek any third-party advice that I wish, including consulting legal counsel, prior to executing this Assumption of Risk and Release. I Understand that this is a release of my rights. I attest that I have read all of this RELEASE understand it and agree to be bound by it. ____________________________________ (Releaser’s Signature)
Date:__________________
EMERGENCY CONTACT AND MEDICAL INFORMATION FORM As stated in the Assumption of Risk and Release above, I have authorized IYSA and any of its officers, employees and agents to secure any and all necessary emergency medical treatment for my child in the event that he/she suffer injury or illness while participating in the camp. In furtherance of this request, I provide the following information, which I represent is accurate and may be relied upon, without further investigation, by any of the foregoing parties seeking to secure my child medical assistance: EMERGENCY CONTACT INFORMATION: Student Name:________________________________________________________________________ Name of Emergency Contact:____________________________________________________________ Relationship of Emergency Contact:______________________________________________________ Phone Number of Emergency Contact:____________________________________________________ HEALTH INSURANCE: Name of Health Insurance Company:______________________________________________________ Name of Policy Holder:________________________________________________________________ Policy Number:_______________________________________________________________________ MEDICAL HEALTH: Current Medication You are Taking:________________________________________________________________________________________________ Medical Conditions Emergency Assistance should be aware of:___________________________________________________________________________ I confirm that I freely and knowing authorize IYSA to use any and all of the information that I am providing herein, including, but not limited to medical-related information, in whatever manner IYSA deems necessary to render assistance to my child in the event of medical emergency. I have read this statement; I fully understand it; and I agree to be legally bound by it. Signature:______________________________________
Date:_________________
Camp Application Ages 3-5 & Ages 5 and up Name:________________________________________ (Print) First Last
Address: _____________________-___________ Street _______________________________________________ City State Zip Code Parent/ Guardian: _________________________ Phone #:(__)___________________Age:______ Emergency #:__________________Sex:______ Birth Date: ______________Ht: ____Wt:______ T-Shirt Size __ Child: _________Adult:____ Position: __________________________ I certify that my child has medical insurance and is physically able to participate in the IYSA Soccer Camp. I agree to allow my child to be treated by a licensed physician while attending, if necessary. I understand if this application is accepted there will be no refund after application is received. ____________________________________________ Signature of Parent/Guardian Date- - - - -
~Coach Alex López~ PBHS Varsity Soccer Coach Indialantic Youth Soccer Kicks4Tots Program Director FYSA License
Objectives Players will be grouped according to their age and ability so they can receive technical and tactical instruction. These camps are designed for both field players and goalkeepers.
Technical
Players will receive skill training from elite level staff coaches during the camp sessions. Our coaches use a variety of fun activities and games to improve footwork, first touch, passing, trapping, heading, shooting, and goalkeeping
Tactical Players will learn many defensive shapes and attacking schemes from coaches who have played all around the world. Everyday at least one hour will be dedicated for small-sided games to work on techniques and strategies under high pressure. This will allow players to use their tactical knowledge, skills and athleticism in full sided games with a team focus and competitive
THE BALL IS THE TEACHER IMPROVE YOUR GAME NOW!!! edge.
[email protected]
Phone
(321) 693-4684 ~Coach Alberto Araujo~ US Soccer National Youth License CBHS Girls Varsity & JV Goal Keeper Coach NSCAA Goalkeeper Level III National License
Email [email protected]
Phone
(321) 427-9636
To register go to www.IYSA.net
INDIALANTIC SUMMER SOCCER CAMP
LOCATION 2000 Hawk Haven Dr, Indialantic, FL 32903 321-693-4684 Camp Dates & Times June 16th-19th June 23rd-26th July 7th-10th Ages 3-4 from 9:00am to 11:00am Ages 5 and up from 9:00am to 2:00pm -Camp PricesCampers 5 and up: $120 (Kicks For Tots) $60 5 players Team Rate: $110 Camp Includes: Lunch, Camp T-shirt Beach Soccer Fun Day !! More touches of the ball makes better players.
ASSUMPTION OF RISK AND RELEASE I,___________________________ parent/legal guardian of ____________________________, (name) (camper name) acknowledge that as a Parent/legal Guardian. I authorize my child to participate in the soccer camp which is being organized by Sport-Specific Training Inc. I recognize that there are direct and inherent risks and hazards associated with this camp, making it a dangerous Activity with the potential to cause injury or loss of limb or life. With full knowledge of these facts and circumstances related to this camp, I knowingly and voluntarily have elected and agreed to allow my child to undertake this Activity, and I agree to assume all responsibility and risk from my child participation in this camp, including, without limitation, all risk of injury or loss of limb or life, property damage and injury to others. I represent to officials of all organizers of the event that I have adequate health insurance necessary to provide for and pay any medical costs that may directly or indirectly result from my child(s) participation in this camp, and I hereby release IYSA, Indialantic Youth Soccer Association and Brevard County Public Parks from any liability for such costs. I further represent to IYSA, BCPP, and Event organizers that my child has no healthrelated reason, condition or problem which would preclude or restrict him/her participation in this camp. I understand that IYSA willingness to allow my child to participate in this Activity stems from these representations. As stated in the Emergency Contract and Medical Information Form below, I authorize IYSA and any of its officers, agents and employees to secure any and all necessary emergency medical treatment for my child in the event he or she suffer injury or illness while participating in this camp. As a parent or legal guardian, I state that I am freely agreeing to assume and take on for myself all of the risks and responsibilities in any way associated with this camp. In consideration of IYSA providing my child the opportunity to participate in this camp; 1. I release IYSA and its trustees, officers, employees and agents from any and all liability, claims and actions that may arise from injury or harm to my child, from his/her death or from damage to his/her property in connection with this camp, and I understand that this Release covers liability, claims and actions caused entirely or in part by any acts or failure to act of IYSA or its trustees, officers, employees or agents, including, without limitation, negligence, mistake or failure to supervise by IYSA 2. I agree to indemnify, defend and hold harmless IYSA and its trustees, officers, employees and agents from any liability, claim or action to a third party caused by child act or omission. I recognize that this Release means I am giving up, among other things, my rights to sue IYSA and its trustees, officers, employees and agents for injuries, damages, or losses that my child may incur. I also understand that this Release binds my heirs, executors, administrators, and assigns, as well as me. I acknowledge that I have had the chance to seek any third-party advice that I wish, including consulting legal counsel, prior to executing this Assumption of Risk and Release. I Understand that this is a release of my rights. I attest that I have read all of this RELEASE understand it and agree to be bound by it. ____________________________________ (Releaser’s Signature)
Date:__________________
EMERGENCY CONTACT AND MEDICAL INFORMATION FORM As stated in the Assumption of Risk and Release above, I have authorized IYSA and any of its officers, employees and agents to secure any and all necessary emergency medical treatment for my child in the event that he/she suffer injury or illness while participating in the camp. In furtherance of this request, I provide the following information, which I represent is accurate and may be relied upon, without further investigation, by any of the foregoing parties seeking to secure my child medical assistance: EMERGENCY CONTACT INFORMATION: Student Name:________________________________________________________________________ Name of Emergency Contact:____________________________________________________________ Relationship of Emergency Contact:______________________________________________________ Phone Number of Emergency Contact:____________________________________________________ HEALTH INSURANCE: Name of Health Insurance Company:______________________________________________________ Name of Policy Holder:________________________________________________________________ Policy Number:_______________________________________________________________________ MEDICAL HEALTH: Current Medication You are Taking:________________________________________________________________________________________________ Medical Conditions Emergency Assistance should be aware of:___________________________________________________________________________ I confirm that I freely and knowing authorize IYSA to use any and all of the information that I am providing herein, including, but not limited to medical-related information, in whatever manner IYSA deems necessary to render assistance to my child in the event of medical emergency. I have read this statement; I fully understand it; and I agree to be legally bound by it. Signature:______________________________________
Date:_________________
Camp Application Ages 3-5 & Ages 5 and up Name:________________________________________ (Print) First Last
Address: _____________________-___________ Street _______________________________________________ City State Zip Code Parent/ Guardian: _________________________ Phone #:(__)___________________Age:______ Emergency #:__________________Sex:______ Birth Date: ______________Ht: ____Wt:______ T-Shirt Size __ Child: _________Adult:____ Position: __________________________ I certify that my child has medical insurance and is physically able to participate in the IYSA Soccer Camp. I agree to allow my child to be treated by a licensed physician while attending, if necessary. I understand if this application is accepted there will be no refund after application is received. ____________________________________________ Signature of Parent/Guardian Date- - - - -
