soccer camp
Location: of Camp: Newman Park 1015 Sand Lane Henderson, KY 42420 Camp Time: 5:30 PM to 7:30 PM Camp Dates : June 8th - June 12th Camp Fee: $75.00 Campers should bring with them everyday of camp:
SOCCER CAMP
Ball, Shin Guards, Soccer Shoes, Water
U6 thru U12 HENDERSON SOCCER CLUB / PYSA
Reminder to wear sun protection!
JUNE 8th thru JUNE 12
Please mail completed application and check payable to:
Contact us at PYSA P.O Box 2071 Henderson, KY 424219
Application should be mailed no later than June 1, 2015
(270)860-0300 or on the web at www.hendersonsoccerclub.net
U6 – U12 Boys & Girls
HENDERSON COUNTY HIGH SCHOOL BOYS HEAD COACH,
BENSON PRYOR & HENDERSON COUNTY HIGH SCHOOL GIRLS HEAD COACH, BEN DEMPSEY. Application should be mailed no later than June 1, 2015
Application
BENSON PRYOR
Player’s First Name:____________________________________________
Benson holds a National D Coaching License and is the Henderson County High Boys’ Head Coach. He has held the head coaching position for five years after heading the JV program for several years. Benson is also one of the Henderson Soccer Club/PYSA valued coaches heading up the U-15 team this year. He was an outstanding player at Henderson County High School.
Player’s Last Name:_____________________________________________
BEN DEMPSEY
Emergency Number:______________________________________________
Ben holds a National D Coaching License and is the Henderson County High Girls' Head Coach. He has been as assistant college coach at Tiffin University and assistant at University of Evansville. Ben’s soccer career includes playing high school ball at Harrison High School, playing one year at D-1, University of Evansville and three years at D-2, University of Southern Indiana. He plans to join the coaching staff at Henderson Soccer Club/PYSA.
Age:____________
Male / Female
T-Shirt Size: YXS YS YM YL S M L Parent or Guardian :_____________________________________________ Cell Phone: ____________________________________________________ Home Phone:___________________________________________________ Address:_______________________________________________________ City:____________________________ State:__________Zip:_________ Emergency Contact: ______________________________________________
HENDERSON SOCCER CLUB/PYSA its agents, officers, and directors hereby disclaim any liability including but not limited to the loss related to theft, property damage, personal injury and death, suffered by the undersigned, of their heirs, executors, administrators, and assigns as a result or in any manner connected with his/her participation in any activities on the PYSA Fields, regardless of the cause. By signing this disclaimer, and in consideration for being permitted on and/or participating in any activities on the PYSA Fields. and the undersigned, his/her heirs, executors, administrators, and assigns agrees not to prosecute or in any way aid in the prosecution of any claim, demand, action, cause of action for damages, costs, damage, personal injury or death suffered by the undersigned, regardless of cause, against PYSA or its agents, officers, and directors. Furthermore, by signing this disclaimer, the undersigned attests that he/she is at least 18 years of age and that he/she has read this document and understands its terms and legal ramifications. Persons under 18 must have their parent/legal guardian sign on behalf, and this disclaimer applies to its full extent to both the parent/legal guardian and person on whose behalf the signature is made.
Camper’s Signature:___________________________________ Parent’s Signature:____________________________________ Insurance Provider:____________________________________ Policy No.:___________________________________________
SOCCER CAMP
Ball, Shin Guards, Soccer Shoes, Water
U6 thru U12 HENDERSON SOCCER CLUB / PYSA
Reminder to wear sun protection!
JUNE 8th thru JUNE 12
Please mail completed application and check payable to:
Contact us at PYSA P.O Box 2071 Henderson, KY 424219
Application should be mailed no later than June 1, 2015
(270)860-0300 or on the web at www.hendersonsoccerclub.net
U6 – U12 Boys & Girls
HENDERSON COUNTY HIGH SCHOOL BOYS HEAD COACH,
BENSON PRYOR & HENDERSON COUNTY HIGH SCHOOL GIRLS HEAD COACH, BEN DEMPSEY. Application should be mailed no later than June 1, 2015
Application
BENSON PRYOR
Player’s First Name:____________________________________________
Benson holds a National D Coaching License and is the Henderson County High Boys’ Head Coach. He has held the head coaching position for five years after heading the JV program for several years. Benson is also one of the Henderson Soccer Club/PYSA valued coaches heading up the U-15 team this year. He was an outstanding player at Henderson County High School.
Player’s Last Name:_____________________________________________
BEN DEMPSEY
Emergency Number:______________________________________________
Ben holds a National D Coaching License and is the Henderson County High Girls' Head Coach. He has been as assistant college coach at Tiffin University and assistant at University of Evansville. Ben’s soccer career includes playing high school ball at Harrison High School, playing one year at D-1, University of Evansville and three years at D-2, University of Southern Indiana. He plans to join the coaching staff at Henderson Soccer Club/PYSA.
Age:____________
Male / Female
T-Shirt Size: YXS YS YM YL S M L Parent or Guardian :_____________________________________________ Cell Phone: ____________________________________________________ Home Phone:___________________________________________________ Address:_______________________________________________________ City:____________________________ State:__________Zip:_________ Emergency Contact: ______________________________________________
HENDERSON SOCCER CLUB/PYSA its agents, officers, and directors hereby disclaim any liability including but not limited to the loss related to theft, property damage, personal injury and death, suffered by the undersigned, of their heirs, executors, administrators, and assigns as a result or in any manner connected with his/her participation in any activities on the PYSA Fields, regardless of the cause. By signing this disclaimer, and in consideration for being permitted on and/or participating in any activities on the PYSA Fields. and the undersigned, his/her heirs, executors, administrators, and assigns agrees not to prosecute or in any way aid in the prosecution of any claim, demand, action, cause of action for damages, costs, damage, personal injury or death suffered by the undersigned, regardless of cause, against PYSA or its agents, officers, and directors. Furthermore, by signing this disclaimer, the undersigned attests that he/she is at least 18 years of age and that he/she has read this document and understands its terms and legal ramifications. Persons under 18 must have their parent/legal guardian sign on behalf, and this disclaimer applies to its full extent to both the parent/legal guardian and person on whose behalf the signature is made.
Camper’s Signature:___________________________________ Parent’s Signature:____________________________________ Insurance Provider:____________________________________ Policy No.:___________________________________________
