brochure
Transcription
brochure
Birthday (M/D/Y)������������������������������������������ Insurance Company���������������������������������������� Policy/Group No.������������������������������������������ MEDICAL INFORMATION Allergic reactions������������������������������������������ Medication presently taking��������������������������������� Past illness or other information that would be useful in the event treatment is necessary�������������������������������� �������������������������������������������������������� �������������������������������������������������������� EMERGENCY NUMBERS Father’s Full Name����������������������������������������� Father’s Phone (home)_________________ (cell)����������������� Mother’s Full Name���������������������������������������� Mother’s Phone (home)________________ (cell)����������������� Name and phone # to call if parents cannot be reached: �������������������������������������������������������� Please check one of the following options and sign: I grant permission to the director, assistants, or other persons responsible for his/her care to act on my behalf for said minor in granting permission for evaluation and treatment of medical problems. I understand that should a major medical problem arise, an attempt will be made to notify me by telephone. In the event that I cannot be reached, I hereby give my consent to such treatment as deemed necessary (including surgery, X-ray examinations and anesthesia to be rendered to said minor by a licensed physician or nurse.) I authorize limited care as follows:������������������������� ������������������������������������������������������ ������������������������������������������������������ ������������������������������������������������������ I, ������������������������������������ , declare that I am the (circle one) father /mother /guardian of the above named minor. Parent/Guardian Signature�������������������������������� Date____________ Jeff Bowers Jeff Bowers, the head women’s soccer coach at Virginia Wesleyan College has compiled an overall record of 237-73-32 with the Marlins and has received numerous accolades, including 2005 Old Dominion Athletic Conference Coach of the Year honors as well as South Region Coach of the Year honors in 2003 and 2005. He guided the Marlins to their most successful season ever in 2006, highlighted by an Old Dominion Conference Championship and a Final Four NCAA finish. He also coached the semi-professional Hampton Road Piranhas, in 2004 and 2005. Bowers holds a Premier License from the National Soccer Coaches Association of America and a “B” license from the United States Soccer Federation. MARLIN SOCCER ACADEMY Minor’s Name��������������������������������������������� at Virginia Wesleyan College To provide prompt care to your minor son or daughter, we must have a new completed consent form on file each year. This way, we can help your child without any delay in an emergency. Meet the Camp Directors Jeff Bowers, Director Virginia Wesleyan College 1584 Wesleyan Drive Norfolk, VA 23502-5599 PARENTAL CONSENT FORM LARGEST SOCCER CAMP IN HAMPTON ROADS MARLIN SOCCER ACADEMY 2016 Soccer Camps ALL LEVELS • BOYS & GIRLS • AGES 6-15 Last Year: 300 campers in BOTH sessions! at Virginia Wesleyan College 2016 SOCCER CAMP Our Philosophy Marlin Soccer Academy is committed to fostering the “love of the game” while developing technical, tactical and physical skills that will enable players to respond to the challenges of soccer in a confident and creative manner. About our Camps Camp Directors Jeff Bowers and Chris Mills will be assisted by nationally licensed coaches and Virginia Wesleyan players selected primarily for their ability to relate with and teach youth players. Emphasis is on individual training as well as teamwork. Each camper will receive a written evaluation at the end of the camp. Day Camps are available to players ages 6 to 15 at all skill levels and offer a positive overall experience in a fun yet challenging atmosphere. Players will be grouped by age and ability. Chris Mills Chris Mills has a 36-15-8 record in his first three years as head men’s soccer coach at Virginia Wesleyan College. A Virginia Beach native, he has been a part of the VWC program as a player and coach since 2002. He was a part of the 2007 Sweet Sixteen team that was the most successful in program history. As head coach, he led the Marlins to their best record since 2007, the ODAC Conference Championship, and an NCAA tournament berth in 2013. In his tenure as head coach, Mills has produced ODAC and Virginia rookies of the year, All-region and AllVirginia honorees, and has been named ODAC Coach of the Year. A 2006 Virginia Wesleyan graduate with a major in Recreation and Leisure Studies, Mills was a standout defensive player for the Marlins. He was a three-time All-ODAC Conference honoree and two-time All-Virginia honoree, helping lead the team to an overall record of 57-17-5, a 27-7-2 ODAC mark, and two NCAA appearances. Mills holds an Advanced National Coaching License from the National Soccer Coaches Association of America. MARLIN SOCCER ACADEMY Goalkeepers will receive specialized instruction each day. July 11-15 Day Camp Session I July 25-29 Day Camp Session II AGES 3-5 Facilities Virginia Wesleyan College is located on a beautiful 300-acre wooded campus. The soccer facilities consist of a Bermuda game field and four practice fields, all exceptionally well maintained. Within 20 minutes are the famous Virginia Beach resort areas and beaches. Open to our campers is the state-of-the-art Batten Student Center which includes: • Elevated Indoor Track • Basketball Courts • Racquetball Courts • Fitness Center • Indoor Soccer • Indoor Swimming Pool M a rl i n S o cce r Ac a d e my AGES 3-5 Enroll Two Ways: Day Camps (ages 6-15) Session I: July 11-15, 9:00–3:00 1. Go to: marlin-soccer-academy.com/virginia-soccer-camps Each Soccer Shots session incorporates the following: • Basic soccer skills • Exclusive Soccer Shots games • Word of the day • Use of imagination • Fun fitness activities and exercises • Coordination, balance and agility development No gear needed! All soccer equipment is provided to program participants. 2. Click “Register Now” for Session I or II 4. Submit your payment Brochure Application 1.Complete the application and parental consent form. Registration is on Monday at 8:30 a.m. and the Closing ceremony is on Friday at 2:30 p.m. Sun. Mon. Tue. Wed. Thu. June https://www.soccershots.org/virginiabeach/ Visit and “Like” us on Facebook at: www.facebook.com/SoccerShots.VirginiaBeach.VA LIMITED AVAILABILITY; REGISTER NOW! TO RESERVE YOUR CHILD’S SPOT Online registration Session II: July 25-29, 9:00–3:00 Register NOW online at: All children ages 3-5 Virginia Wesleyan College July 11th – 15th 9:30-11:30 or July 25th – 29th 9:30-11:30 $100 includes T-Shirt and Camp Certificate Register online at https://www.soccershots.org/virginiabeach/ Laura Koontz at [email protected] or (757) 377-5986 ENROLLMENT INFORMATION Marlin Soccer Academy Schedule 3. Submit your details Soccer Shots® is a uniquely designed program that will introduce soccer to your child in a fun, safe and controlled environment. We offer soccer sessions where we teach basic soccer skills, fun games and healthy competition to your child. Our program also emphasizes character-forming lessons such as fair play, individual concentration, cooperation and encouragement. Who: Where: When: Cost: How: Contact: Ag es 6-15 July August Fri. Sat. 26 27 28 29 30 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 22 23 24 25 26 27 28 29 30 31 1 6 19 2 20 3 21 4 5 Friends/Team/Sibling Team Request To ensure having your child grouped in the same team, please place a request on the on-line notes column or when registering your child. 2016 Corporate Sponsor Pick Up Policy At the end of each day campers and parents will meet at the Trinder Center (Soccer Stadium) What to Bring Soccer cleats Water bottle Shin guards Indoor shoes Towel Toiletries Sunblock Bathing Suit Swimming for campers will vary between 8:00 and 10:00 am Tuesday through Friday 2.Include a $50 check or deposit money order payable to: “Marlin Soccer Academy” 3. Mail application with payment to: Jeff Bowers Virginia Wesleyan College 1584 Wesleyan Drive Norfolk, VA 23502-5599 4. Team Discount: Teams of ten or more receive a $25.00 discount. Please include team names, team roster and applications sent in one envelope with your team contact. To hold your spot, you may also fax your application and • • consent form to: (757) 461-2262 YOUR CLEARED CHECK OR ONLINE CREDIT CARD PAYMENT CONFIRMS YOUR ENROLLMENT. E-MAIL CONFIRMATION UPON RECEIVED APPLICATION. Medical Insurance Although a physical examination is not required, each player must have a completed parental consent form on file (located on the reverse side of the application). Fees/Deposit The fee is $235 per camp. A $50 non-refundable deposit is charged for each player and must be submitted with the application. The balance is due at registration. The fee includes a T-shirt, evaluation, camp ball and lunch on Friday. Cancellation/Refund Policy If a player is unable to attend camp, please notify us at least 10 days before the start date. Fees will be refunded minus the $50 non-refundable deposit. Once the camp begins, there are no refunds. Trainer An Athletic Trainer will be on-site all week. MARLIN SOCCER ACADEMY at Virginia Wesleyan College 2016 SOCCER CAMP APPLICATION Please complete the Parental Consent form on the back of this application. Name���������������������������������������������� Address�������������������������������������������� City���������������������� State_______ Zip__________ Date of Birth������������������ Age on 7/1/16__________ Parent/Guardian������������������������������������� Parent/Guardian Phone (home) ������������������������ (work)������������������������� Parent/Guardian E-mail��������������������������������������������� Shirt Size (circle): Youth S M L Adult S M L XL Please select Camp(s) – $235 Full Day Day Camp Session I – July 11 -15 Day Camp Session II – July 25 - 29 Please select Position(s) Field Player Goalkeeper Combination Field / Goalkeeper Team Discount (10 or more players) – $25 per player Team Name����������������������������������������� Deposit: A $50 non-refundable deposit is charged per player and must accompany this application with the balance to be paid at registration. For team discounts, the deposits must be submitted as a group four weeks prior to the camp start date. Cancellation/Refund Policy: If a player is unable to attend camp, the player will be charged the $50 non-refundable deposit and the balance of the payment will be refunded. Once the camp begins, there are no refunds. Make checks payable to: Mail application with check to: Marlin Soccer Academy Jeff Bowers Virginia Wesleyan College 1584 Wesleyan Drive Norfolk, VA 23502-5599 Or, to hold your spot, fax to: (757) 461-2262 For more information, contact our Camp Directors: Lunch Campers bring their lunch Monday-Thursday. Friday we will have pizza provided!! Jeff Bowers – (757) 455-3285 / [email protected] Chris Mills – (757) 455-3120 / [email protected] Visit our website at http://www.marlin-soccer-academy.com