CAMP / CAMPER INFO
MEDICAL INFO
Camper’s physician / Phone number
Dates: July 12—July 16, 2009
______________________________________________
Registration & Check-in: 6:00p.m. on Sunday July 12
Date of last tetanus toxoid:________________________
Allergic reactions?:______________________________
Camp ends at 12:00pm on Thursday July 16
Medication presently taking______________________
This camp caters to the high school student who seeks to
sharpen her skill level and has a strong desire to play at the
collegiate level. The camp is open to any and all entrants who
are presently in the 9th, 10th, 11th, or 12th grade. The camp
will give the student-athlete the opportunity to be coached
and evaluated by the Liberty University soccer staff. Each
player will learn how the college recruiting process works,
what coaches are looking for in a player, and how to better
present herself as a college prospect through the use of resumes, video tape, etc.
Past illnesses or information that would be useful in
the event of treatment necessary:
______________________________________________
Your insurance company_________________________
Agent’s name___________________________________
Policy #_______________ Phone #________________
Any instructions regarding your insurance?
______________________________________________
Parental Consent Form
This completed form will enable health facilities in Lynchburg and
camp medical staff to provide prompt care to your minor son or
daughter. All areas of this form must be completed prior to camp
registration. I/We, the undersigned, hereby certify that I/we
am/are the parent or legal guardian of the camper. I hereby give
permission for the staff of the camp to seek, during the period of
the camp, appropriate medical attention for the camper, and for
medical attention to be given, and for the camper to receive medical attention in the event of accident, injury, or illness. I/we will be
responsible for any and all cost of medical attention and treatment.
I/We, the undersigned, for ourselves and as guardian(s) of
____________________________ (camper’s name) understand
that soccer is an active, physical sport, and that injuries can take
place during play. I/We understand that, as with any sport, injuries
can occur, and we hereby admit that our child is physically and
mentally capable of participating in soccer and camp activities.
I/We represent that I/We have sought the opinion of our child’s
pediatrician, ___________________, and he concurs that,__
_____________ is fully capable of safely engaging in these activities. I/We also understand that it is my/our responsibility in caring
for the camper listed above, to be assured that he/she is fully capable of engaging in this sports activity, and I/we are confident that
he/she is able to engage in such sport. I/We, the undersigned, for
ourselves, our heirs, executors and administrators, waive, release
and forever discharge Liberty Women’s Soccer Camp, Adam
Godwin and his staff, officers, agents, employees, representatives,
successors and assign of and from all rights and claims for damages, injury, or loss to person or property which may be sustained
or occur during participation in camp activities or while at camp,
whether or not damage, injury, or loss is due to negligence.
Signature of parent or guardian
___________________________________________________
Date ______________________________________________
Please fill out the application and parental consent form and
return it with your $100 deposit to reserve your space at
camp.
Transportation
Each camper is responsible for her own transportation to
and from camp. Lynchburg Regional Airport is serviced by
US Air and Delta. The bus service is Greyhound (1-800-2312222). Arrangements for pick-ups and drop-offs need to be
expressed to Adam Godwin (Camp Director) at 770-3305131 or [email protected].
Date of Birth____________________________________
Daily devotions
•
Tactical Training
Email__________________________________________
•
Small-sided games
•
Home Phone____________________________________
Liberty Soccer T-shirt
•
College Recruiting Presentation
•
Written Evaluation
•
Technical Training
•
Goalkeeper Training
•
Camp Tournament
•
Qualified Athletic Trainer On Camp Staff
Club Team_____________________________________
•
Supervised Evening Activities
T-Shirt Size_____________________________________
Emergency Phone_______________________________
Parent(s) / Guardian (s)
_______________________________________________
_______________________________________________
July 12 - July 16
Grades 9—12
Preferred Position________________________________
Cost
Refunds
The cost of the camp is $350.00 and includes four nights
lodging, 10 meals (breakfast on Monday through breakfast
on Thursday), and a Liberty Soccer t-shirt. The cost of a
commuter camper is $275 and includes lunch and dinner
Monday thru Wednesday, and a Liberty Soccer t-shirt.
Group discounts are available, contact Adam Godwin for
full details. Please include the full amount of the camp with
your application OR a $100 deposit. If paying a deposit,
balance will be due at registration.
Should you have an unfortunate circumstance and have to
cancel your attendance, please do so before July 1, 2009. A
$50 administrative fee will be deducted from your deposit.
No refunds will be issued once camp begins.
Liberty Women’s Soccer Camp **
770-330-5131
[email protected]
Name__________________________________________
•
** Please make checks payable to:
Women’s
Soccer Camp
Camper Information
Address
_______________________________________________
_______________________________________________
_______________________________________________
Camper Benefits
2009 Liberty Lady
Flames
2000, 2001, 2005 Big South Champions
2000, 2001, 2005 NCAA Tournament
1999, 2006 Big South Runners-up
Rules & Regulations
Individuals are required to comply with the rules & regulations of Liberty University and the Liberty Lady Flames
Women’s Soccer Camp. A copy of these rules will be sent to
you in a registration package upon receipt of your application. Any camper who does not abide by these rules may be
dismissed without refund.
Fill out consent form and return to address below to
reserve your place at camp. SPACE IS LIMITED:
Liberty University, c/o Adam Godwin, FOC, 1971
University Blvd., Lynchburg, VA 24502