Gator Elite Soccer Camp July 25-26, 2015 - sidearm.sites.s3
Allegheny College
Soccer Camp Application Name Address City/State/Zip Home Phone (
)
Cell Phone (
)
G
E
L
L
A
E
T
I
L
E
H
E
N
Y
Player Email
Gator Elite Soccer Camp July 25-26, 2015
Parent Email Age
Ht.
Wt.
High School Team: Club Team: Position: This September: Grade
Age
M
L
C
S
A
Adult :
M
P
T-shirt size (circle one) XL
Please send a Gator Elite Camp brochure to my friend at:
Name
For boys ages 15-18
Address
Rising Sophomores,
City/State/Zip
Juniors, and Seniors
Email
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 135-98-29 (fourteen years) Ex-professional indoor soccer player (Harrisburg Heat and Baltimore Blast) “A” coaching license with the United States Soccer Federation (USSF)
Nate Whitehurst Assistant Coach, Men’s Soccer
Completed second season at Allegheny as an assistant coach 4-year player at Division II LeniorRhyne University in Hickory, NC. NSCAA Advanced National Diploma NSCAA Goalkeeping Level II Diploma
About the Camp Gator Elite Camp: July 25-26 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 Saturday and two sessions Sunday Check-in starts noon on Saturday, July 25 Camp ends at 3:00 on Sunday, July 26
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 - July 25-26 (Sat.-Sun.) $225 fee: includes room & board Sign Up by June 5th. Fee $200
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 26. After June 26, please call the soccer office to register.
Date Home Phone
Send form and payment to: Gator Elite Soccer Camp Allegheny College—Box AC 520 North Main Street Meadville, PA 16335 (814) 332-5208
Parent Cell Phone Insurance Co. Policy Number Secondary Emergency Contact Name Secondary Emergency Contact Phone
For More Information
Please advise of special health conditions (attach separate sheet)
Angelo Panzetta Phone: 814-332-5208 Email: [email protected] Nate Whitehurst Phone: 814-332-2856 Cut here
Email: [email protected]
http://alleghenygators.com
Soccer Camp Application Name Address City/State/Zip Home Phone (
)
Cell Phone (
)
G
E
L
L
A
E
T
I
L
E
H
E
N
Y
Player Email
Gator Elite Soccer Camp July 25-26, 2015
Parent Email Age
Ht.
Wt.
High School Team: Club Team: Position: This September: Grade
Age
M
L
C
S
A
Adult :
M
P
T-shirt size (circle one) XL
Please send a Gator Elite Camp brochure to my friend at:
Name
For boys ages 15-18
Address
Rising Sophomores,
City/State/Zip
Juniors, and Seniors
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 135-98-29 (fourteen years) Ex-professional indoor soccer player (Harrisburg Heat and Baltimore Blast) “A” coaching license with the United States Soccer Federation (USSF)
Nate Whitehurst Assistant Coach, Men’s Soccer
Completed second season at Allegheny as an assistant coach 4-year player at Division II LeniorRhyne University in Hickory, NC. NSCAA Advanced National Diploma NSCAA Goalkeeping Level II Diploma
About the Camp Gator Elite Camp: July 25-26 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 Saturday and two sessions Sunday Check-in starts noon on Saturday, July 25 Camp ends at 3:00 on Sunday, July 26
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 - July 25-26 (Sat.-Sun.) $225 fee: includes room & board Sign Up by June 5th. Fee $200
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 26. After June 26, please call the soccer office to register.
Date Home Phone
Send form and payment to: Gator Elite Soccer Camp Allegheny College—Box AC 520 North Main Street Meadville, PA 16335 (814) 332-5208
Parent Cell Phone Insurance Co. Policy Number Secondary Emergency Contact Name Secondary Emergency Contact Phone
For More Information
Please advise of special health conditions (attach separate sheet)
Angelo Panzetta Phone: 814-332-5208 Email: [email protected] Nate Whitehurst Phone: 814-332-2856 Cut here
Email: [email protected]
http://alleghenygators.com
