Regular Indoor with Walls
THE CAMP will run for 4 days, June 15th through June 18th from 6-8pm. FOR upcoming graders
2nd
-8th
COST Younger Age Group (Incoming 2nd - 4th grade) $65 Older Age Group (Incoming 5th - 8th grade) $75 *$10 Early Bird discount per athlete if postmarked by May 18th *$5 Family Plan discount per athlete for siblings BRING YOUR CLEATS OR GYM SHOES, A BALL AND SHIN GUARDS BE READY TO LEARN AND HAVE FUN!
Emergency Contact Info: Name_____________________________ Relationship________________________ Phone_____________________________ List any medical problems and or restrictions __________________________________ __________________________________ We hereby agree that Lakota West High School, its members, coaches, or officers shall not be liable for any injury or loss which my child (or children) may sustain while participating in activities of any kind, whether sponsored by or under the supervision of Lakota West’s staff and we agree to indemnify and to hold harmless Lakota West High school, Firebird Soccer Camp, its members, coaches, officers or designates of any kind from any claim whatsoever. Authorization for Medical Treatment for a Minor: I (name) ________________; the parent/ guardian of the above child, give my permission and consent to assigned head coach of my child's Firebird Youth Soccer Camp for approval of emergency treatment, after consultation with medical staff, for my child in the case of my absence. This authorization is good for the Firebird Youth Soccer Camp. HS Soccer Camp only. Signature__________________________ Date__________ Medical Insurance (Yes or No) Name of Company __________________________________
Make checks payable to Lakota West Athletic Department Mail checks and registration form to: Jan Bennett 8080 Nieman Dr. Cincinnati, Oh. 45224 LOCATION The turf field at Lakota West High School 8940 Union Centre Blvd. West Chester, Ohio 45069
LAKOTA WEST FIREBIRDS GIRLS SOCCER CAMP REGISTRATION
Name of Player: __________________________ Address: __________________________ City, State, Zip: __________________________ Phone: __________________________ Email: __________________________ Grade Next Fall_____________ T-Shirt Size: (Circle one, adult sizes) Youth-Large Xlarge Adult- Small Medium Large XLarge Parents name(s)___________________ __________________________ FREE T-SHIRT INCLUDED IF REGISTRATION IS RECEIVED BY MAY 25TH!
Staff
Jan Bennett- Lakota West Women’s Varsity Head Soccer Coach John Vogt- Lakota West Women’s Assistant Varsity/ Head JV Soccer Coach Sam Rolsen- Lakota West Women’s Varsity Assistant Coach/ GK Coach AND, Firebird Soccer Players!
LAKOTA WEST WOMEN’S SOCCER YOUTH CAMP 2015 JUNE 15-JUNE 18 6-8PM LAKOTA WEST TURF STADIUM
2nd
-8th
COST Younger Age Group (Incoming 2nd - 4th grade) $65 Older Age Group (Incoming 5th - 8th grade) $75 *$10 Early Bird discount per athlete if postmarked by May 18th *$5 Family Plan discount per athlete for siblings BRING YOUR CLEATS OR GYM SHOES, A BALL AND SHIN GUARDS BE READY TO LEARN AND HAVE FUN!
Emergency Contact Info: Name_____________________________ Relationship________________________ Phone_____________________________ List any medical problems and or restrictions __________________________________ __________________________________ We hereby agree that Lakota West High School, its members, coaches, or officers shall not be liable for any injury or loss which my child (or children) may sustain while participating in activities of any kind, whether sponsored by or under the supervision of Lakota West’s staff and we agree to indemnify and to hold harmless Lakota West High school, Firebird Soccer Camp, its members, coaches, officers or designates of any kind from any claim whatsoever. Authorization for Medical Treatment for a Minor: I (name) ________________; the parent/ guardian of the above child, give my permission and consent to assigned head coach of my child's Firebird Youth Soccer Camp for approval of emergency treatment, after consultation with medical staff, for my child in the case of my absence. This authorization is good for the Firebird Youth Soccer Camp. HS Soccer Camp only. Signature__________________________ Date__________ Medical Insurance (Yes or No) Name of Company __________________________________
Make checks payable to Lakota West Athletic Department Mail checks and registration form to: Jan Bennett 8080 Nieman Dr. Cincinnati, Oh. 45224 LOCATION The turf field at Lakota West High School 8940 Union Centre Blvd. West Chester, Ohio 45069
LAKOTA WEST FIREBIRDS GIRLS SOCCER CAMP REGISTRATION
Name of Player: __________________________ Address: __________________________ City, State, Zip: __________________________ Phone: __________________________ Email: __________________________ Grade Next Fall_____________ T-Shirt Size: (Circle one, adult sizes) Youth-Large Xlarge Adult- Small Medium Large XLarge Parents name(s)___________________ __________________________ FREE T-SHIRT INCLUDED IF REGISTRATION IS RECEIVED BY MAY 25TH!
Staff
Jan Bennett- Lakota West Women’s Varsity Head Soccer Coach John Vogt- Lakota West Women’s Assistant Varsity/ Head JV Soccer Coach Sam Rolsen- Lakota West Women’s Varsity Assistant Coach/ GK Coach AND, Firebird Soccer Players!
LAKOTA WEST WOMEN’S SOCCER YOUTH CAMP 2015 JUNE 15-JUNE 18 6-8PM LAKOTA WEST TURF STADIUM
