OSYSA/Soccer Unlimited CampRegistration Form

Guardian AngelsSoccer Camp 2016

Date/TimeAugust 15-19, 2016 from 1-4 PM

Cost:$89.00 per participant (please make checks out to OSYSA)

2 or more per family: 10% discount

Location:ArmlederPark

Name, first/last______/______

Home address______

City______State_____ Zip______

Home ph.______

Work ph.______Cell ph. ______(mom)

Work ph.______Cell ph. ______(dad)

Email______

Date of birth______Present age______

If you have participated in the Soccer Unlimited Camp before please check here: ____

Medical Release:

I hereby agree that the local organizing soccer group and the OSYSA/Soccer Unlimited Clinic/Camp shall not be liable for any injury or loss which my child(ren) may sustain while participating in this soccer clinic/camp, and I agree to indemnify and to hold harmless the organizing soccer group and/or the OSYSA/Soccer Unlimited Clinic/Camp from any claim whatsoever.

The above applicant/player is in good health and has my permission to participate in this program. In case of emergency, I grant permission for my son/daughter to be given emergency treatment at a local hospital.

______Date______

(Signature)

Please indicate any medical problems on an extra piece of paper

2016

OSYSA/Soccer Unlimited 2ndAnnual

Guardian AngelsSoccer Camp

Info Sheet

CampDirector: Jack Hermans

Jack Hermans, Director of OSYSA/Soccer Unlimited is an ex-professional player from Holland.

After an injury forced him to cut short his playing career, Jack turned his attention to coaching youth teams (ages 12-19) in Holland. He has been coaching in the USA for 34 years andis currently on the coaching staff with various clubs in Greater Cincinnati as the Director of Training.

Jack was the head coach at XavierUniversity from 1990-2004. He has worked with the Ohio South Olympic Development Program and trains various soccer clubs in Greater Cincinnati. He was voted “Coach of the Year” in 1985 by the Cincinnati Enquirer while coaching at AndersonHigh School. In 1994 Jack led his college team to a Midwestern Collegiate Conference Title. He was voted “MCC Coach of the Year” in 1992 and “OCSA Coach of the Year” in 2002. He was inducted into the “Ohio Hall of Fame” for soccer in 2007. Jack holds the prestigious Dutch Full Badge and USSF A-license. He holds a M.ED from XavierUniversity. Each year Jack works with more than 1200 youth soccer players.

Directions to ArmlederPark:

From Hyde Park: Turn L onto Linwood Ave/OH-561 S. Continue to follow OH-561 S. OH-561 S becomes Beechmont Ave./OH-125/32 (0.3 miles). Turn slight R onto Wilmer Ave. (0.1 miles). Turn slight R onto Beechmont Circle (0.4 miles). Turn L onto Wooster Rd. (0.4 miles). End at ArmlederPark at 5059 Wooster Pike45226. Camp is held close to the picnic shelter.

Bring a soccer ball, plenty of water, a dark colored and white T-shirt, sunscreen lotion and dress appropriate according to the weather.

Mail check and registration form to:

Chris Beerman

1784 Berkshire Club Dr.

Cincinnati, Ohio 45230

Make checks payable to OSYSA

Guardian Angels is listed as “private” so you cannot register over the internet

For other OSYSA/Soccer Unlimited Camps:

or for more info:

Chris Beerman

Email:

Phone: 513-288-9782