For 1st through 6th graders

Hosted by Coach Khrys Dundr

Varsity Men’s Soccer Coach – Clover High School, U12 Boys – Palmetto United Futbol Club, Volunteer Assistant Soccer Coach – Winthrop University Women’s Soccer, USSF B license

PROGRAM &OBJECTIVE: This is a 7 Session Skill Training Program. Players will be involved in a fun, fast paced, learningenvironment where Skill Development Activities & Games will help them improve their soccer skills

CURRICULUM: Players will learn skills in the following areas: Dribbling Moves, One-on-One, Fast Footwork, Passing, Receiving, and other exciting aspects of the game!

DATES:

1 / 2 / 3 / 4 / 5 / 6 / 7
Dec.
1 / Dec.
8 / Dec.
15 / Jan.
5 / Jan.
12 / Jan. 19 / Jan. 26

Session

Saturday

LOCATION & TIME: Oakridge Middle School Gym, 1557 Hwy 557, Clover, SC 29710

1st– 3rdGraders: 9 – 10 am & 4th – 6th Graders: 10 – 11am

PLAYER ELIGIBILITY: 1stgrade through 6th grade only; Boys & Girls

WHAT YOU NEED: a size 4 soccer ball, non-marking indoor/tennis shoes, energy and excitement

FEE: Fee per player is $50 for all 7 sessions through pre-registration (includes a t-shirt), $75 to register for all 7 sessions at the first session (includes a t-shirt) or $10 per session paid the day of the clinic (may purchase a t-shirt for $10 (quantities limited)

REGISTRATION: Pre-register by following instructions below; may register on the first day in person

STEPS TO REGISTER:

1 Complete “Player Registration Information” section

2 Sign “Medical Form and Parent/Guardian Authorization & Waiver”

3 Follow instructions for registration and payment

GOLDEN GOAL SOCCER ACADEMY – WINTER CLINIC

PLAYER REGISTRATION INFORMATION

Name / Nickname
Male Female
Address
City / State / Zip
Home Phone / Work Phone / Cell Phone
Email
Grade entering Fall 2011: / Date of birth: / Age:
Parent /Guardian 1: / Relationship
Address (if different)
City / State / Zip
Email (for confirmation)
Home Phone: / Work Phone: / Cell Phone:
Parent /Guardian 2: / Relationship
Address (if different)
City / State / Zip
Email (for confirmation)
Home Phone: / Work Phone: / Cell Phone:
Emergency Contact (if parent/guardian not available):
Address / Relationship:
City / State / Zip
Phone #1: / Phone #2: / Authorized Pickup Yes No

Please circle one T-shirt size for camp t-shirt.

Youth S M L Adult S M L XL

Medical Form
Health/Accident Insurance Co.
Policy # / Policy Holder Name:
Physician Name: / Phone:
Medical allergies:
Medications:
Food allergies:
Other allergies:
Special information:

Parent/Guardian Authorization & Waiver

I hereby verify that all my child’s immunizations are up to date, that my child has had a recent physical examination, and that my child is physically able to participate in the Golden Goal Soccer Academy camp and the above information is complete and accurate to my knowledge. I hereby grant permission for my child to receive first aid and emergency treatment by the staff of the Golden Goal Soccer Academy in the event of illness or injury, or by the hospital emergency room in case I cannot be reached immediately. I have no knowledge of any physical condition that would be affected by the above named athlete’s participation in the camp. I voluntarily waive any claims against the Golden Goal Soccer Academy, Oakridge Middle School, the Clover School District, Camp/Staff Personnel, and/or other person(s) transporting my child, against all liability, claims, damages, attorney fees and expenses arising out of or in connection with any activities of the Golden Goal Soccer Academy camps/clinics. I also certify that the above mentioned organizations are not responsible for any personal property that may be lost, stolen or damaged during the camp/clinic. I understand that the Golden Goal Soccer Academy and its’ affiliates do notprovide health or accident insurance and my child is insured by my medical insurance. I agree to notify the camp of any changes prior to the start of the camp/clinic sessions.

Print Name:______

Signature: ______

Date: ______

Payment Methods

Please send Fee with Completed Registration Form and Completed Medical Form/Parent/Guardian Authorization & Waiver

Regular Mail (Check) - Address below

Checks Made Payable to:Clover Men’s Soccer

Golden Goal Soccer Academy – Winter Clinic

Attn: Coach Khrys Dundr

Oakridge Middle School

1557 Hwy 557

Clover, SC 29710

Contact: Coach Khrys Dundr – 803-631-8000 or

Coach Brian Ringer – 803-493-5658 or