Girls Soccer ID Camp
Insurance Information & Waiver
ABOUT PITT‐JOHNSTOWN
INSURANCE CARRIER
NCAA Division II, PSAC Conference
GROUP NUMBER
Mascot: Mountain Cat
AGREEMENT NUMBER
3,000 Student Enrollment
PRIMARY CARE PHYSICIAN
48 Undergraduate majors with 7 aca‐
demic divisions PHYSICIAN PHONE #
Average class size: 25 RESPONSIBILITY STATEMENT
The University of Pittsburgh‐Johnstown is not re‐ sponsible for any damage, expense, or inconvenience, nor any loss, injury or damage to or of any person or property from any cause whatsoever incurred during the ID Camp. The University of Pittsburgh‐Johnstown is not held respon‐ sible for any act, omission or any event during this pro‐ gram. Only in cases of emergency will the player be taken for medical treatment. Parents/guardians are responsible for transporting players for non‐emergency treatment. My child is in good physical condition, and I accept responsibil‐ ity for her during this program. I have read the above statement and agree with the provi‐ sions. I understand there is a risk in this activity. I give my permission for my child to participate.
Student‐to‐Faculty Ratio: 17‐1 First and largest regional campus of
University of Pittsburgh Founded in 1927 655 acre campus in the Laurel High‐
lands Located 70 miles east of Pittsburgh
PARENT/GUARDIAN NAME
CHILD'S NAME AGE If your child has any serious or potentially serious conditions, please specify below.
University of Pittsburgh—Johnstown Women’s Soccer
450 Schoolhouse Road
June 24‐26, 2016
PARENT/GUARDIAN SIGNATURE:
Johnstown, PA 15904 814‐269‐7174 DATE:
PittJohnstownAthletics.com
For all in grades 9‐12
ABOUT THE ID CAMP
Pitt‐Johnstown Girls Soccer ID Camp
The Pitt‐Johnstown Girls Soccer ID Camp is for girls entering 9‐12 grade in Fall 2016. Every camper will receive collegiate level coaching from Head Coach Rachel Gironda, entering her 4th season at Pitt‐ Johnstown this fall. Before leading the lady cats into the highly competitive PSAC Conference, Coach Gi‐ ronda was a 3‐time Division II All American and Na‐ tional Champion runner‐up as a player and was also an assistant coach at Southern New Hampshire Uni‐ versity. Along with Coach Gironda, the camp staff includes assistant coaches Gena Pentz and Oleg Ami‐ nov along with current Pitt‐Johnstown players.
REGISTRATION FORM
Campers will take part in 7 training sessions to include small‐sided and full‐sided games. Goalkeeper specific training will also be provided. Campers will also take part in a recruiting discussion to learn what college coaches are looking for in players and the recruiting process.
Commuter ‐ $175 Residential ‐ $225
TENTATIVE SCHEDULE Friday, June 24
Name
12:30 pm
Check In
2:00 pm
All Camp Meeting
2:30‐4:30 pm
Training Session #1
5:00 pm
Dinner
6:30‐8:00 pm
Training Session #2
8:30 pm
Meeting – Recruiting
Address City State
Zip Code
Phone Email
Saturday, June 25 7:30 am
Breakfast
Parent/Guardian
9:00‐11:00 am
Training Session #3
Emergency Phone
11:30 am
Lunch
1:00‐3:00 pm
Training Session #4
7 Collegiate level training sessions
5:00 pm
Dinner
Camp t‐shirt
6:30‐8:00 pm
Training Session #5
CAMP FEATURES
Residential Campers:
High School Graduation Year Club Team Position (s):
Sunday, June 26
GK
D
M
F
‐ 6 meals
7:30 am
Breakfast
T‐shirt size (Adult):
‐ 2‐night stay in supervised dorm
9:00‐11:00 am
Training Session #6
How did you find out about our camp?
Commuter Campers:
11:30 am
Lunch
‐ 4 meals (lunch and dinner only)
2:00‐3:30 pm
Training Session #7
‐ Can be dropped off and picked up at the Fieldhouse each day
4:00 pm
Check Out
COST
QUESTIONS?
$175 per commuter camper
For more information, contact:
$225 per residential camper
Rachel Gironda Head Women’s Soccer Coach Phone: 814‐269‐7174 Email: [email protected]
$50 non‐refundable deposit to reserve your spot; balance due at check in
Registration Deadline: June 10, 2016
S
M
L
XL
Make checks payable to and mail completed form (see reverse side) and $50 non‐refundable deposit to: PITT‐JOHNSTOWN SUMMER CAMPS Athletic Department—Women’s Soccer 450 Schoolhouse Road Johnstown, PA 15904
ABOUT PITT‐JOHNSTOWN
INSURANCE CARRIER
NCAA Division II, PSAC Conference
GROUP NUMBER
Mascot: Mountain Cat
AGREEMENT NUMBER
3,000 Student Enrollment
PRIMARY CARE PHYSICIAN
48 Undergraduate majors with 7 aca‐
demic divisions PHYSICIAN PHONE #
Average class size: 25 RESPONSIBILITY STATEMENT
The University of Pittsburgh‐Johnstown is not re‐ sponsible for any damage, expense, or inconvenience, nor any loss, injury or damage to or of any person or property from any cause whatsoever incurred during the ID Camp. The University of Pittsburgh‐Johnstown is not held respon‐ sible for any act, omission or any event during this pro‐ gram. Only in cases of emergency will the player be taken for medical treatment. Parents/guardians are responsible for transporting players for non‐emergency treatment. My child is in good physical condition, and I accept responsibil‐ ity for her during this program. I have read the above statement and agree with the provi‐ sions. I understand there is a risk in this activity. I give my permission for my child to participate.
Student‐to‐Faculty Ratio: 17‐1 First and largest regional campus of
University of Pittsburgh Founded in 1927 655 acre campus in the Laurel High‐
lands Located 70 miles east of Pittsburgh
PARENT/GUARDIAN NAME
CHILD'S NAME AGE If your child has any serious or potentially serious conditions, please specify below.
University of Pittsburgh—Johnstown Women’s Soccer
450 Schoolhouse Road
June 24‐26, 2016
PARENT/GUARDIAN SIGNATURE:
Johnstown, PA 15904 814‐269‐7174 DATE:
PittJohnstownAthletics.com
For all in grades 9‐12
ABOUT THE ID CAMP
Pitt‐Johnstown Girls Soccer ID Camp
The Pitt‐Johnstown Girls Soccer ID Camp is for girls entering 9‐12 grade in Fall 2016. Every camper will receive collegiate level coaching from Head Coach Rachel Gironda, entering her 4th season at Pitt‐ Johnstown this fall. Before leading the lady cats into the highly competitive PSAC Conference, Coach Gi‐ ronda was a 3‐time Division II All American and Na‐ tional Champion runner‐up as a player and was also an assistant coach at Southern New Hampshire Uni‐ versity. Along with Coach Gironda, the camp staff includes assistant coaches Gena Pentz and Oleg Ami‐ nov along with current Pitt‐Johnstown players.
REGISTRATION FORM
Campers will take part in 7 training sessions to include small‐sided and full‐sided games. Goalkeeper specific training will also be provided. Campers will also take part in a recruiting discussion to learn what college coaches are looking for in players and the recruiting process.
Commuter ‐ $175 Residential ‐ $225
TENTATIVE SCHEDULE Friday, June 24
Name
12:30 pm
Check In
2:00 pm
All Camp Meeting
2:30‐4:30 pm
Training Session #1
5:00 pm
Dinner
6:30‐8:00 pm
Training Session #2
8:30 pm
Meeting – Recruiting
Address City State
Zip Code
Phone Email
Saturday, June 25 7:30 am
Breakfast
Parent/Guardian
9:00‐11:00 am
Training Session #3
Emergency Phone
11:30 am
Lunch
1:00‐3:00 pm
Training Session #4
7 Collegiate level training sessions
5:00 pm
Dinner
Camp t‐shirt
6:30‐8:00 pm
Training Session #5
CAMP FEATURES
Residential Campers:
High School Graduation Year Club Team Position (s):
Sunday, June 26
GK
D
M
F
‐ 6 meals
7:30 am
Breakfast
T‐shirt size (Adult):
‐ 2‐night stay in supervised dorm
9:00‐11:00 am
Training Session #6
How did you find out about our camp?
Commuter Campers:
11:30 am
Lunch
‐ 4 meals (lunch and dinner only)
2:00‐3:30 pm
Training Session #7
‐ Can be dropped off and picked up at the Fieldhouse each day
4:00 pm
Check Out
COST
QUESTIONS?
$175 per commuter camper
For more information, contact:
$225 per residential camper
Rachel Gironda Head Women’s Soccer Coach Phone: 814‐269‐7174 Email: [email protected]
$50 non‐refundable deposit to reserve your spot; balance due at check in
Registration Deadline: June 10, 2016
S
M
L
XL
Make checks payable to and mail completed form (see reverse side) and $50 non‐refundable deposit to: PITT‐JOHNSTOWN SUMMER CAMPS Athletic Department—Women’s Soccer 450 Schoolhouse Road Johnstown, PA 15904
