One week of technical and tactical training for girls and boys age
5 — 14 while having fun!
June 11 —15, 2012, 8:30 AM—12:30 PM
$40 registration
Water balloons & Slip ‘n Slide the last day!
Each player receives a soccer jersey and soccer ball! Free lunch is available.
Location:
Time:
Wear/Bring:
Indian Village Elementary School
3835 Wenonah Lane, Fort Wayne
8:30 AM—12:30 PM
Shin guards, soccer cleats or sneakers, water, snack, sun screen and bug
repellant if desired. On Friday there will be a water balloon battle and the
kids should have extra clothing, a towel and a supply of filled water
balloons.
Camp director: Donahue Stewart, NSCAA National Diploma and member, USSF National Youth, USSF ‘D’ License, USSF
Indoor Official, US Soccer Coaches Organization Member, former Citadel Soccer head men’s coach and Warsaw Wave
soccer coach
For more information and to download application: www.innercitysoccer.com or contact
Annie Herman (English y Español), 260-750-1917 or Donahue Stuart, 260-580-2513.
Registration and payment can be dropped off at Study, Indian Village or Lindley Schools
or mailed to:
Inner City Soccer, Inc., PO Box 11021, Fort Wayne, IN 46855.
REGISTRATION, HEALTH STATEMENT, WAIVER AND AUTHORIZATION
Name:
Shirt size:
Address:
City:
Phone:
Cell:
Zip:
Work:
E-Mail:
Birth Date:
/
/
Parents:
Alternate contact:
M
F
Phone:
School:
Grade in fall:
EMERGENCY AND HEALTH INFORMATION
Physician:
Hospital Preference:
Is there any medical condition we should be aware of? Yes No If yes, Please explain:
RELEASE AGREEMENT & AUTHORIZATION:
This is to certify that all information supplied herein is accurate to the best of my knowledge. I hereby release and discharge Inner City Soccer, Inc. of Fort Wayne, and all its members, representative, coaches, referees or designates of the
Corporation and all sponsors from any and all liability from any claims I have or may have because of injury to my child
(said youth) as a participant prior to, during and after the soccer camp. In case of any accident or illness I give permission for my child to be given medical treatment as deemed appropriate. I will assume responsibility for any medical bills
incurred by my child at a local hospital or local Clinic.
Signature of Parent or Guardian:
Date:
Inner City Soccer, Inc is a 501 (C) (3) Not-For-Profit Corporation Registered in the State of Indiana