Minnesota State University Moorhead Athletics ...
Minnesota State University Moorhead Department Of Intercollegiate Athletics Youth Programs Consent For Participation And Medical Information Regular Session and Position Camp
Child’s Name _________________________________ Age __________ In case of emergency, contact ___________________________________ Emergency contact phone #____________________________________ Medical Insurance Co._________________________________________ Policy No. __________________________ Group No. _______________ Physician Name _____________________________________________ Phone ______________________________________________________ Medical conditions the youth program staff and medical emergency services personnel need to be made aware of:
What to bring
▸▸ Soccer Ball. Every camper is responsible for his/her own ball. ▸▸ Water Bottle. Every camper should bring his/her own water bottle to fill up at the provided water stations. ▸▸ SNACK – Bring your own snack (There will be a designated snack time) ▸▸ Cleats for outdoor training ▸▸ Flat-soled shoes/sneakers for indoor training ▸▸ Shin Guards ▸▸ FREE CAMP T-SHIRT ▸▸ Water and sport drinks will be provided
___________________________________________________________ ___________________________________________________________ I wish to register my minor child, ____________________ and consent to my child’s participation in the Summer Sports Camps and/or Leagues sponsored by the Department of Intercollegiate Athletics of Minnesota State University Moorhead during the summer.
For more information contact: Rollie Bulock Head Women's Soccer Coach 218.477.2320
I recognize that participation in recreational and instructional activities, even when well supervised and managed, pose a risk of physical injury to my child, and I agree to assume such a risk on behalf of my child. I understand that children registered for MSUM Athletics’ summer sport camps and/or leagues will receive instruction in the basic principles of sport(s) of their choice(s) and will spend a significant amount of time practicing and performing sporting techniques and/or researching and performing a variety of enrichment techniques under the supervision of experienced instructors, and I consent to my child’s participation in this program. I certify that my child has no medical condition or impairment, including the use of medication, that might inhibit his participation. RELEASE OF LIABILITY I, the undersigned, hereby hold Minnesota State University Moorhead and the entire MSUM Dragon Athletics' Staff harmless from liability for any and all medical and/or accident expenses which my minor child may incur during his involvement in the Summer Sports camps and/ or leagues at the Department of Intercollegiate Athletics, MSUM. I hereby certify that my child is provided coverage via personal health and accident insurance in effect which is sufficient to cover any and all of the expenses, noted above, which might incur. Parent/Guardian Signature: ____________________________________ Print Parent/Guardian Name:___________________________________
June 15-18, 2015 Minnesota State University Moorhead is an equal opportunity educator and employer and is a member of the Minnesota State Colleges and Universities System. This information will be made available in alternate format upon request by contacting Disability Services at 218.477.4318 (voice) or 1.800.627.3529 (MRS/TTY).
Dragons Youth
Soccer camp
Age Groups (Boys and Girls)
▸▸ Mighty Dragons: 4 -6 year olds ▸▸ Super Dragons: 7 -9 year olds ▸▸ Jr. Dragons: 10-12 year olds ▸▸ Elite Dragons: 13-14 year olds
Camp Overview The Dragon Youth Soccer Camp is for boys and girls from ages 4 to 14 years old. The camp is designed for players of all levels from the Fargo-Moorhead-West Fargo community and surrounding area that are interested in learning the game of soccer. The camp will be conducted in the morning at the MSUM soccer facilities. During the four day camp, campers will learn technical skills they can utilize in games. Trained by the MSUM women’s soccer team, the dragon soccer camp will give young players the opportunity to work with collegiate level players. In addition, the curriculum will provide fun, but challenging training sessions that will enhance the camper’s knowledge and ability. Our camp is perfect for individuals that want to improve their soccer skills while having fun in a great environment.
Camp Caching Staff Rollie Bulock Head Women's Soccer Coach 218.477.2320 | [email protected] Uchenna Ogbonnaya MSUM Women’s Soccer Asst. Coach Jon Melendez MSUM Women’s Soccer Asst. Coach Anna Hulteng MSUM Women’s Soccer Speed and Agility Coach
Soccer Camp Scholarship A camp scholarship is available through inSports Foundation to help reduce costs to attend. Please visit insportsfoundation.org for more information.
Cost: $75, includes T-shirt. Write the check to: MSUM WOMEN SOCCER
The camp’s coaching staff is composed of highly qualified players and coaches with numerous years of playing and coaching at the collegiate level, high school level, and youth level. The coaching staff is experienced in both teaching and demonstrating the necessary skills for a camper to achieve his/her full potential. The coaches are knowledgeable in all positions on the field, including GK training.
Signature_________________________________________________ Date__________________
Cost: $75.00 FREE CAMP T-SHIRT
Coaching Staff
Send U.S. Funds Only to: MSUM Women Soccer Attention– Dragon Youth Camp 1104 7th Ave S Moorhead, MN 56563 (Checks payable to MSUM Women Soccer)
The philosophy of the camp is player development. During the four day duration of the camp, the players will build their arsenal of technical and tactical skills that will help them become proficient soccer players.
I give permission to Dragons Soccer Camp to Photograph/videotape my child during camp sessions.
Camp philosophy
Ages: 4-14 year old (Boys and Girls) Time: 9:30am-12:00pm Registration begins from 9-9:30am Location: Women’s Game Field on the MSUM Campus (North of Nemzek Hall on 6th avenue south, Moorhead MN)
2015 MSUM Dragon Youth Camp Registration Form
June 15-18
Camper’s Name_______________________________________________________________________________________________________________________ Address______________________________________________________ City_________________________________ State___________ Zip_________________ Phone (Home)_________________________________ Email_________________________________________________________________________________ Age___________ Height_____________ T-Shirt Size (circle): Youth Size: S M L XL XXL OR Adult Size: S M L XL XXL Age Group (circle): Might Dragons (ages 4-6) Super Dragons (ages 7-9) Jr. Dragons (ages 10-12) Elite Dragons (ages 13-14) School______________________________________________________________________________ Please note any medical conditions that we should be aware of (attach an additional sheet if necessary)_______________________________________________ ____________________________________________________________________________________________________________________________________
Soccer Dragons Youth Soccer Camp
Child’s Name _________________________________ Age __________ In case of emergency, contact ___________________________________ Emergency contact phone #____________________________________ Medical Insurance Co._________________________________________ Policy No. __________________________ Group No. _______________ Physician Name _____________________________________________ Phone ______________________________________________________ Medical conditions the youth program staff and medical emergency services personnel need to be made aware of:
What to bring
▸▸ Soccer Ball. Every camper is responsible for his/her own ball. ▸▸ Water Bottle. Every camper should bring his/her own water bottle to fill up at the provided water stations. ▸▸ SNACK – Bring your own snack (There will be a designated snack time) ▸▸ Cleats for outdoor training ▸▸ Flat-soled shoes/sneakers for indoor training ▸▸ Shin Guards ▸▸ FREE CAMP T-SHIRT ▸▸ Water and sport drinks will be provided
___________________________________________________________ ___________________________________________________________ I wish to register my minor child, ____________________ and consent to my child’s participation in the Summer Sports Camps and/or Leagues sponsored by the Department of Intercollegiate Athletics of Minnesota State University Moorhead during the summer.
For more information contact: Rollie Bulock Head Women's Soccer Coach 218.477.2320
I recognize that participation in recreational and instructional activities, even when well supervised and managed, pose a risk of physical injury to my child, and I agree to assume such a risk on behalf of my child. I understand that children registered for MSUM Athletics’ summer sport camps and/or leagues will receive instruction in the basic principles of sport(s) of their choice(s) and will spend a significant amount of time practicing and performing sporting techniques and/or researching and performing a variety of enrichment techniques under the supervision of experienced instructors, and I consent to my child’s participation in this program. I certify that my child has no medical condition or impairment, including the use of medication, that might inhibit his participation. RELEASE OF LIABILITY I, the undersigned, hereby hold Minnesota State University Moorhead and the entire MSUM Dragon Athletics' Staff harmless from liability for any and all medical and/or accident expenses which my minor child may incur during his involvement in the Summer Sports camps and/ or leagues at the Department of Intercollegiate Athletics, MSUM. I hereby certify that my child is provided coverage via personal health and accident insurance in effect which is sufficient to cover any and all of the expenses, noted above, which might incur. Parent/Guardian Signature: ____________________________________ Print Parent/Guardian Name:___________________________________
June 15-18, 2015 Minnesota State University Moorhead is an equal opportunity educator and employer and is a member of the Minnesota State Colleges and Universities System. This information will be made available in alternate format upon request by contacting Disability Services at 218.477.4318 (voice) or 1.800.627.3529 (MRS/TTY).
Dragons Youth
Soccer camp
Age Groups (Boys and Girls)
▸▸ Mighty Dragons: 4 -6 year olds ▸▸ Super Dragons: 7 -9 year olds ▸▸ Jr. Dragons: 10-12 year olds ▸▸ Elite Dragons: 13-14 year olds
Camp Overview The Dragon Youth Soccer Camp is for boys and girls from ages 4 to 14 years old. The camp is designed for players of all levels from the Fargo-Moorhead-West Fargo community and surrounding area that are interested in learning the game of soccer. The camp will be conducted in the morning at the MSUM soccer facilities. During the four day camp, campers will learn technical skills they can utilize in games. Trained by the MSUM women’s soccer team, the dragon soccer camp will give young players the opportunity to work with collegiate level players. In addition, the curriculum will provide fun, but challenging training sessions that will enhance the camper’s knowledge and ability. Our camp is perfect for individuals that want to improve their soccer skills while having fun in a great environment.
Camp Caching Staff Rollie Bulock Head Women's Soccer Coach 218.477.2320 | [email protected] Uchenna Ogbonnaya MSUM Women’s Soccer Asst. Coach Jon Melendez MSUM Women’s Soccer Asst. Coach Anna Hulteng MSUM Women’s Soccer Speed and Agility Coach
Soccer Camp Scholarship A camp scholarship is available through inSports Foundation to help reduce costs to attend. Please visit insportsfoundation.org for more information.
Cost: $75, includes T-shirt. Write the check to: MSUM WOMEN SOCCER
The camp’s coaching staff is composed of highly qualified players and coaches with numerous years of playing and coaching at the collegiate level, high school level, and youth level. The coaching staff is experienced in both teaching and demonstrating the necessary skills for a camper to achieve his/her full potential. The coaches are knowledgeable in all positions on the field, including GK training.
Signature_________________________________________________ Date__________________
Cost: $75.00 FREE CAMP T-SHIRT
Coaching Staff
Send U.S. Funds Only to: MSUM Women Soccer Attention– Dragon Youth Camp 1104 7th Ave S Moorhead, MN 56563 (Checks payable to MSUM Women Soccer)
The philosophy of the camp is player development. During the four day duration of the camp, the players will build their arsenal of technical and tactical skills that will help them become proficient soccer players.
I give permission to Dragons Soccer Camp to Photograph/videotape my child during camp sessions.
Camp philosophy
Ages: 4-14 year old (Boys and Girls) Time: 9:30am-12:00pm Registration begins from 9-9:30am Location: Women’s Game Field on the MSUM Campus (North of Nemzek Hall on 6th avenue south, Moorhead MN)
2015 MSUM Dragon Youth Camp Registration Form
June 15-18
Camper’s Name_______________________________________________________________________________________________________________________ Address______________________________________________________ City_________________________________ State___________ Zip_________________ Phone (Home)_________________________________ Email_________________________________________________________________________________ Age___________ Height_____________ T-Shirt Size (circle): Youth Size: S M L XL XXL OR Adult Size: S M L XL XXL Age Group (circle): Might Dragons (ages 4-6) Super Dragons (ages 7-9) Jr. Dragons (ages 10-12) Elite Dragons (ages 13-14) School______________________________________________________________________________ Please note any medical conditions that we should be aware of (attach an additional sheet if necessary)_______________________________________________ ____________________________________________________________________________________________________________________________________
Soccer Dragons Youth Soccer Camp
