SUMMER SOCCER CAMP SERIES 2015
Charlotte Soccer Academy
S AN NT LY TH U R EA RE KE CO S UP MO TA DI N R O P G O T SI E F EK CAM N E I L 1 W OF N O GE TA N VA AD
2015 Summer Soccer Camp Series Application Camper's Name _______________________________________________________________________________ Shirt Size (circle)
YS
YM
YL
AS
AM
AL
Male
Female
Address ______________________________________________________________________________________ City, State, Zip ________________________________________________________________________________ Phone# (1) ________________________________ Phone# (2) _______________________________________ Age at Camp ____________ Birth Date _______________________ E-mail: _______________________________________________________________________________________ Save $... register on-line at www.charlottesocceracademy.com
SUMMER SOCCER CAMP SERIES 2015
the camp you would like to attend.
6/8 - 6/12
Dynamic Speed and Agility - in conjunction with Architech Sports
5:30 pm - 7:30 pm
$190 mail-in application
6/15 - 6/19
Youth Elite Camp I
9:00 am - 12:30 pm
$190 mail-in application
6/15 - 6/19
Youth Elite Camp II
9:00 am - 12:30 pm
$190 mail-in application
6/15 - 6/19
Becoming a Better Defender/Midfielder Camp
5:00 pm - 8:30 pm
$190 mail-in application
6/22 - 6/26
Ball Mastery Camp I
9:00 am - 12:00 pm
$190 mail-in application
6/22 - 6/26
Ball Mastery Camp II
5:00 pm - 8:00 pm
$190 mail-in application
7/6 - 7/10
BMW Sports Elite Camp
9:00 am - 12:30 pm
$190 mail-in application
7/6 - 7/10
Goalkeeping and Striker Camp
5:00 pm - 8:00 pm
$190 mail-in application Ball Mastery Camp - CSA North
6/22 - 6/26
9:00 am - 12:00 pm
$190 mail-in application
5:00 pm - 8:00 pm
9:00 am - 11:30 am
Youth Elite Camp I
Youth Elite Camp II
9:00 am - 12:30 pm
9:00 am - 12:30 pm
Camp Directors: Mark Thornton & Patrick Daka Ages: Rising U8-U11 (Boys and Girls)
OrthoCarolina Sportsplex
Camp Director: Raymond Fraser Ages: Rising U12-U13 (Boys and Girls)
OrthoCarolina Sportsplex
June 15th - 19th
June 22nd - 26th
June 22nd - 26th
Becoming a Better Defender/ Midfielder Camp
Ball Mastery Camp l
Ball Mastery Camp ll
5:00 pm - 8:30 pm
Camp Directors: Jim Finnerty & Dan Dudley Ages: Rising U8-U18 (Boys and Girls) OrthoCarolina Sportsplex
9:00 am - 12:00 pm
5:00 pm - 8:00 pm
Camp Director: Mark Thornton Ages: Rising U8-U12 (Boys and Girls) OrthoCarolina Sportsplex
Camp Director: Mark Thornton Ages: Rising U13-U18 (Boys and Girls) OrthoCarolina Sportsplex
July 6th - 10th
Goalkeeping and Striker Camp - CSA North
BMW Sports Elite Camp
Goalkeeping and Striker Camp
Recreation Elite Camp - CSA North
Camp Director: Brad Wylde Ages: Rising U6-U18 (Boys and Girls) OrthoCarolina Sportsplex
Camp Directors: Joe Crump & Mark Thornton Ages: Rising U8-U18 (Boys and Girls) OrthoCarolina Sportsplex
CSA North Camps
Recreation Program Camps
9:00 am - 12:30 pm
PARENT CONSENT FORM The undersigned hereby certifies to be the parent or legal guardian of _________________, and certifies that my child is physically fit, mentally capable, and medically qualified to participate in the Charlotte Soccer Academy 2015 Soccer Camp activities. _____________________, the above child’s physician, concurs that my child is fully capable of safely participating in these activities. I understand that soccer is an active physical sport and that injuries can occur. I understand that every effort will be made to contact me in case of an emergency concerning my child. However, if I cannot be reached and/or if time is of the essence, I hereby give permission for the camp staff to seek appropriate medical attention for my child, for medical attention to be given to and received by my child in the event of accident, illness, or injury during the period of the camp, should it be deemed necessary by camp personnel. I will be responsible for any and all cost of medical attention and treatment. I, the undersigned, for myself and my heirs, executors and administrators, waive, release, and forever discharge the Charlotte Soccer Academy Summer Camp Series 2015 and it’s employees from all rights and claims for damages, injury, or loss to person or property which may be sustained or incurred during participation in soccer camp activities. I confirm the following about my child. (If “yes”, please give details on a separate sheet.) PLEASE CIRCLE Medical conditions: YES NO Allergies: YES NO Birth deformities: YES NO Past Illnesses: YES NO Fractures or other disabilities: YES NO Contact Lenses: YES NO Pre-existing injury currently under treatment: YES NO Date of last tetanus immunization ___________________________ Child’s health insurance company ________________________________________________________ Policy #_______________________________ Name of policy holder____________________________ Signature of parent or guardian________________________________ Date: ________________________
June 15th - 19th 9:00 am - 12:00 pm
www.charlottesocceracademy.com
6/22 - 6/25
$125 mail-in application
Dynamic Speed and Agility
Camp Director: Luke Williams Ages: Rising U8-U18 (Boys and Girls) OrthoCarolina Sportsplex
Register Online Under the Camps/Events Tab
Recreation Elite Camp
9:00 am - 11:30 am
June 15th - 19th
In Conjunction with Architect Sports Performance
Recreation Program Camps 6/29 - 7/2
June 15th - 19th
July 6th - 10th
CSA North Camp Program 6/15 - 6/19
June 8th - 12th 5:30 pm to 7:30 pm
Charlotte Soccer Academy Camps 901 Sam Newell Road, Suite E Matthews, NC 28105
Please check
5:00 pm - 8:00 pm
June 29th - July 2nd 9:00 am - 11:30 am
Ball Mastery Camp - CSA North
Recreation Elite Camp
June 22nd - 26th
June 22nd - 25th
Goalkeeping and Striker Camp
Recreation Elite Camp CSA North
Camp Director: Matt Denton Ages: Rising U8-U18 CSA North Complex (Boys and Girls)
5:00 pm - 8:00 pm
Camp Director: Matt Denton Ages: U8 - U18 CSA North Complex (Boys and Girls)
Camp Director: Jim Finnerty Ages: Rising U5-U18 (Boys and Girls) OrthoCarolina Sportsplex
9:00 am - 11:30 am
Camp Director: Meanu Kayea Ages: Rising U5-U18 CSA North Complex (Boys and Girls)
Save money and time by securing your place early and registering online
www.charlottesocceracademy.com
S AN NT LY TH U R EA RE KE CO S UP MO TA DI N R O P G O T SI E F EK CAM N E I L 1 W OF N O GE TA N VA AD
2015 Summer Soccer Camp Series Application Camper's Name _______________________________________________________________________________ Shirt Size (circle)
YS
YM
YL
AS
AM
AL
Male
Female
Address ______________________________________________________________________________________ City, State, Zip ________________________________________________________________________________ Phone# (1) ________________________________ Phone# (2) _______________________________________ Age at Camp ____________ Birth Date _______________________ E-mail: _______________________________________________________________________________________ Save $... register on-line at www.charlottesocceracademy.com
SUMMER SOCCER CAMP SERIES 2015
the camp you would like to attend.
6/8 - 6/12
Dynamic Speed and Agility - in conjunction with Architech Sports
5:30 pm - 7:30 pm
$190 mail-in application
6/15 - 6/19
Youth Elite Camp I
9:00 am - 12:30 pm
$190 mail-in application
6/15 - 6/19
Youth Elite Camp II
9:00 am - 12:30 pm
$190 mail-in application
6/15 - 6/19
Becoming a Better Defender/Midfielder Camp
5:00 pm - 8:30 pm
$190 mail-in application
6/22 - 6/26
Ball Mastery Camp I
9:00 am - 12:00 pm
$190 mail-in application
6/22 - 6/26
Ball Mastery Camp II
5:00 pm - 8:00 pm
$190 mail-in application
7/6 - 7/10
BMW Sports Elite Camp
9:00 am - 12:30 pm
$190 mail-in application
7/6 - 7/10
Goalkeeping and Striker Camp
5:00 pm - 8:00 pm
$190 mail-in application Ball Mastery Camp - CSA North
6/22 - 6/26
9:00 am - 12:00 pm
$190 mail-in application
5:00 pm - 8:00 pm
9:00 am - 11:30 am
Youth Elite Camp I
Youth Elite Camp II
9:00 am - 12:30 pm
9:00 am - 12:30 pm
Camp Directors: Mark Thornton & Patrick Daka Ages: Rising U8-U11 (Boys and Girls)
OrthoCarolina Sportsplex
Camp Director: Raymond Fraser Ages: Rising U12-U13 (Boys and Girls)
OrthoCarolina Sportsplex
June 15th - 19th
June 22nd - 26th
June 22nd - 26th
Becoming a Better Defender/ Midfielder Camp
Ball Mastery Camp l
Ball Mastery Camp ll
5:00 pm - 8:30 pm
Camp Directors: Jim Finnerty & Dan Dudley Ages: Rising U8-U18 (Boys and Girls) OrthoCarolina Sportsplex
9:00 am - 12:00 pm
5:00 pm - 8:00 pm
Camp Director: Mark Thornton Ages: Rising U8-U12 (Boys and Girls) OrthoCarolina Sportsplex
Camp Director: Mark Thornton Ages: Rising U13-U18 (Boys and Girls) OrthoCarolina Sportsplex
July 6th - 10th
Goalkeeping and Striker Camp - CSA North
BMW Sports Elite Camp
Goalkeeping and Striker Camp
Recreation Elite Camp - CSA North
Camp Director: Brad Wylde Ages: Rising U6-U18 (Boys and Girls) OrthoCarolina Sportsplex
Camp Directors: Joe Crump & Mark Thornton Ages: Rising U8-U18 (Boys and Girls) OrthoCarolina Sportsplex
CSA North Camps
Recreation Program Camps
9:00 am - 12:30 pm
PARENT CONSENT FORM The undersigned hereby certifies to be the parent or legal guardian of _________________, and certifies that my child is physically fit, mentally capable, and medically qualified to participate in the Charlotte Soccer Academy 2015 Soccer Camp activities. _____________________, the above child’s physician, concurs that my child is fully capable of safely participating in these activities. I understand that soccer is an active physical sport and that injuries can occur. I understand that every effort will be made to contact me in case of an emergency concerning my child. However, if I cannot be reached and/or if time is of the essence, I hereby give permission for the camp staff to seek appropriate medical attention for my child, for medical attention to be given to and received by my child in the event of accident, illness, or injury during the period of the camp, should it be deemed necessary by camp personnel. I will be responsible for any and all cost of medical attention and treatment. I, the undersigned, for myself and my heirs, executors and administrators, waive, release, and forever discharge the Charlotte Soccer Academy Summer Camp Series 2015 and it’s employees from all rights and claims for damages, injury, or loss to person or property which may be sustained or incurred during participation in soccer camp activities. I confirm the following about my child. (If “yes”, please give details on a separate sheet.) PLEASE CIRCLE Medical conditions: YES NO Allergies: YES NO Birth deformities: YES NO Past Illnesses: YES NO Fractures or other disabilities: YES NO Contact Lenses: YES NO Pre-existing injury currently under treatment: YES NO Date of last tetanus immunization ___________________________ Child’s health insurance company ________________________________________________________ Policy #_______________________________ Name of policy holder____________________________ Signature of parent or guardian________________________________ Date: ________________________
June 15th - 19th 9:00 am - 12:00 pm
www.charlottesocceracademy.com
6/22 - 6/25
$125 mail-in application
Dynamic Speed and Agility
Camp Director: Luke Williams Ages: Rising U8-U18 (Boys and Girls) OrthoCarolina Sportsplex
Register Online Under the Camps/Events Tab
Recreation Elite Camp
9:00 am - 11:30 am
June 15th - 19th
In Conjunction with Architect Sports Performance
Recreation Program Camps 6/29 - 7/2
June 15th - 19th
July 6th - 10th
CSA North Camp Program 6/15 - 6/19
June 8th - 12th 5:30 pm to 7:30 pm
Charlotte Soccer Academy Camps 901 Sam Newell Road, Suite E Matthews, NC 28105
Please check
5:00 pm - 8:00 pm
June 29th - July 2nd 9:00 am - 11:30 am
Ball Mastery Camp - CSA North
Recreation Elite Camp
June 22nd - 26th
June 22nd - 25th
Goalkeeping and Striker Camp
Recreation Elite Camp CSA North
Camp Director: Matt Denton Ages: Rising U8-U18 CSA North Complex (Boys and Girls)
5:00 pm - 8:00 pm
Camp Director: Matt Denton Ages: U8 - U18 CSA North Complex (Boys and Girls)
Camp Director: Jim Finnerty Ages: Rising U5-U18 (Boys and Girls) OrthoCarolina Sportsplex
9:00 am - 11:30 am
Camp Director: Meanu Kayea Ages: Rising U5-U18 CSA North Complex (Boys and Girls)
Save money and time by securing your place early and registering online
www.charlottesocceracademy.com
