Medical & Insurance Information
The hospital requests that we have insurance information available as well as your name and phone number.
In the event you are not available for parental consent,
The hospital medical staff may proceed with medical
treatment.
INSURANCE COMPANY
___________________________________________
___________________________________________
POLICY NUMBER
___________________________________________
Please indicate any medical concerns we should
be aware of:
___________________________________________
___________________________________________
___________________________________________
Read and sign the following release:
We, the undersigned parent(s) and or legal guardian(s)
of a camp participant under the age of 21 years, do
herby agree that he or she may participate in the
Edinboro University Soccer Camp.
In consideration that he or she has been accepted by the
Edinboro University Camp for instructions we do further agree for and on behalf of him or her and for ourselves individually that we will assume all risks associated
with any portion of the camp including traveling to and
participating in activities while on campus. In cooperation with such course of instruction we will bind Edinboro University and the enacting staff harmless against
all claims for damage to person or property while traveling or participating in this activity on campus.
SIGNATURE OF PARENT/GUARDIAN
____________________________DATE:__________
Women’s ID
Camp
July 12 - 15, 2017
7/12 – Check In – 12:30 pm
7/15 – Check Out – 11:00 am
Sample Daily Schedule
7:30-8:30
9:00-11:45
12:00-1:45
2:00-4:45
4:45-6:00
6:30-8:15
9:00-10:30
10:30
Breakfast
Team Training
Lunch
Team Training
Dinner
Scheduled Games
Match Day Analysis
Lights Out
Edinboro
University
Soccer Camp
Edinboro University
of Pennsylvania
Women’s ID
Camp
**Bring swimsuits for swimming facilities**
3 Games Guaranteed
Evaluation at the End of Camp
All teams will have certified USSF
or NSCAA coaches. Every day will
end with match analysis with the
respective coach.
July 12 - 15, 2017
“Technical, Tactical,
and Mental Total
Player Development”
Camp Staff
Gary Kagiavas
•Head Women’s Coach – Edinboro University
•Former Assistant Coach – Gannon University
•Two-time PSAC Coach of the Year
•Former Professional Player
•USSF & South African Coaching Licenses
•MSA Coaching Director
•Erie Premier Sports Camp Director
Camp Philosophy
The Edinboro Soccer Camp is designed to make you a
better player. You will be schooled in ways to not only
train with your team, but also in ways to train on your
own. Our staff of international and collegiate coaches
offer you intense individual technical training.
The skills you will learn at each training session can
immediately be put to use in the small-sided games. You
are encouraged to try what you have learned.
Registration
$330 per camper for Highlands Dorms
*A goalkeeping coach will be present to work
exclusively with the goalkeepers daily*
To reserve a place in residential camp,
send this application form back in the mail along
with payment.
Mail to: P.O. Box 541, Fairview, PA 16415
Rene Lawrence
•Head Women’s Coach – Lake Erie College
•Youth Club Coach – Whitecaps Soccer Club
Bill Pfeiffer
•PA West ODP Staff Coach
•Head Women’s Coach – Moon Area High School
•Youth Club Coach
Chet Gapzynski
•Region 1 ODP Staff Coach
•PA West ODP Staff Coach
•Director of Coaching – FC Pittsburgh
Jamie Sallie
•Assistant Women’s Coach – Edinboro University
•Youth Club Coach – MSA
Buddy Cooper
•Assistant Women’s Coach – Lake Erie College
•Youth Club Coach-Excalibur Soccer Club
As well as contributing to the local community, our goal
at Edinboro University is to offer quality personal instructions to youth players at an affordable price so every
player has the ability and facilities to improve their soccer
skills.
Facilities
Edinboro University features recreational facilities such as
an AAU-size pool, basketball complete gymnasium,
racquetball, sand volleyball, bookstore, and convenient
store and bank.
Teams will stay in the new, state of the art Highlands
dormitories. Rooms are 4 players per room and include
air-conditioning. Each player is responsible for bringing
their own sheets, towels, and toiletries.
The University is only 18 miles south of Erie and 100
miles from the cultural centers of Pittsburgh, Cleveland,
and Buffalo.
When traveling north or south on I-79, take the Edinboro
exit and follow RT. 6N to Edinboro.
Edinboro Soccer
Camp Application
Name __________________________________
Address ________________________________
City _______________ State ___ Zip ________
Date of Birth ____________________________
Grad Year ______________________________
Parent/Guardian __________________________
Cell Phone ______________________________
Email___________________________________
Please check your choice
___ Field player
___ Goalkeeper
Please check your choice
___ I am purchasing the camp ball
(Please enclose payment of $25 for the ball
with your application)
___ I will bring my own ball
For additional information, contact:
Gary Kagiavas
814-732-1876
Please circle your t-shirt size
S
M L
XL