PANTHER YOUTH SOCCER CAMP
2017
Led by the Belgrade High School soccer coaches, the Panther Youth Soccer
Camp builds technical and tactical soccer skills in a fun and age-appropriate
environment. All players who register before June 17th receive a free T-shirt
and water bottle with registration.
RESGISTRATION
Player’s last name:
Player’s first name:
DOB (MM/DD/YY):
Grade for 2017-18
Academic year:
Address:
City:
______/________/____________
Camp level (check one)
☐ mini panther – grade
☐ youth panther 6th – 8th grade
☐ high school 9th – 12th grade
1st
Parent email address:
YES or NO
Medical conditions?
Player medications?
T-shirt size (circle one):
Youth unisex:
S
5th
Parent last name:
Player allergies?
Middle name:
YES or NO
YES or NO
Adult:
Parent first name:
men’s
XS
S
If yes, please list:
If yes, please list:
If yes, please list:
IN CASE OF EMERGENCY
Name of emergency contact:
Emergency contact phone number, email:
Relationship:
State:
Zip code:
M
L
or
women’s
M
L
XL
Parent cell phone #:
Participation Waiver
Panther Youth Soccer Camp
I, the parent/guardian of ______________________________(player name), a minor, agree that the
player and I will abide by the rules and regulations of the Panther Youth Soccer Camp
(PYSC), its affiliated organizations, and its sponsors. In consideration of the player’s
participation in the soccer programs and activities of PYSC, I, for myself, the player and our
respective heirs, administrators, and successors, intending to be legally bound, hereby
release and indemnify PYSC, the owners and operators of the facilities used for the
programs, and their respective coaches, assistant coaches, directors, employees, sponsors,
and representatives against all claims, liabilities, damages, or causes of action arising out of
or in connection with the player’s participation in the programs including, without
limitation, player’s transportation to/from any program which transportation is hereby
authorized.
As the parent/legal guardian of the PLAYER, I request that in my absence the above named
player be transported to any hospital or medical facility for diagnosis and treatment. I
request and authorize licensed medical personnel (physicians, dentists, technicians or
nurses) to perform any diagnostic procedures, treatment procedures, operative
procedures, and x-ray treatment of the above minor. I have not been given a guarantee as
to the results of examination or treatment.
Player Name:______________________________________________________________________
Parent/Guardian Name: ______________________________________________________________
Parent/Guardian Signature: ___________________________________________________________
Date: ______________________
Photograph Release
I further grant Panther Youth Soccer Camp the right to use the player’s name, picture,
and/or likeness in printed, broadcast, social media, and other material concerning the
programs provided such use is related to the player’s status as a participant in the
programs.
Player Name:______________________________________________________________________
Parent/Guardian Name: ______________________________________________________________
Parent/Guardian Signature: ___________________________________________________________
Date: ______________________
CAMP INFORMATION
Eligible players
Youth Camp: boys and girls entering 1st - 8thth grade for the 2017-18 school year. No
previous soccer experience is necessary!
High School Camp: boys and girls entering 9th -12th grade at Belgrade High School
Head Coaches
Ric Plante – BHS Boys Varsity soccer coach, MYSA Director of Coaching, Montana ODP
Director
Celine Valentin – BHS Girls Varsity soccer coach, Blitzz FC coach, PYSC Owner/Director
Joel Ganey – Blitzz FC Technical Director and coach
Time and cost
Section
Mini panther
Youth panther
High school
Grade
1st - 5th
6th - 8th
9th - 12th
Day
July 17-20
July 17-20
July 17-21
Time
8:30am – 10:30am
8:30am – 11:00am
1:00pm – 4:00pm
Family discount: additional family members can take $10 off their registration fee.
Payment
Please mail the registration form, waiver and payment to:
Panther Youth Soccer Camp
Box 5200
Bozeman, MT 59717
Cost
$75
$85
$120
Checks should be
made payable to
Celine Valentin
Location
Belgrade High School soccer complex. 701 Spooner Rd, Belgrade, MT.
What to bring
Cleats, soccer socks, a soccer ball, and water. Shin guards are mandatory for players of all
ages! T-shirts will be available on the first day of camp. Players with medical conditions are
required to bring any necessary medication to camp.
Refunds and late registration
Registration is due by June 17th. Players who register after June 17th may be accepted, but
will not be guaranteed a shirt and/or water bottle. Full refunds are available for
registrations canceled before June 17th, 2017. Partial refunds are available through July
14th. Cancelations made after July 14th will not be refunded.
Contact
Email Celine Valentin at [email protected] with any
questions about the Panther Youth Soccer Camp.
Connect with us on Facebook! @PantherYouthSoccerCamp