UNK SOCCER ACADEMY
Soccer Camp @ Scottsbluff, NE – Boys & Girls
July 14th & 15th, 2015
Landers Soccer Complex
Train with UNK Coaches and Players!
Director: John Maessner - UNK Head Coach, NCAA Div I National Champion,
3 Time Major League Soccer Champion & Former DC United Director of Youth Development!
MAIL-IN REGISTRATION FORM:
LIMITED SPACE – REGISTER ONLINE TODAY TO RESERVE YOUR SPOT HERE: LoperCamps.com
NAME: _______________________
DATE OF BIRTH: _______________
AGE: ________ Grade: _____________
SCHOOL NAME & CLUB TEAM NAME: _________________________________ Positions: ________________________
PLAYER PHONE: ________________
PLAYER EMAIL: ____________________________________________________
PARENT/GUARDIEN NAMES: ___________________________ PARENT/GAURDIEN PHONE: _______________________
PARENT/GUARDIEN EMAIL ADRESSES: ___________________________________________________________________
HOME ADDRESS: _______________________________________
STATE: ______
ZIP: ________________
EMERGENCY CONTACT NAME AND PHONE: ______________________________________________________________
Includes UNK Soccer Academy t-shirt!
PLAYER SHIRT SIZE: YS YM YL YXL AS AM AL AXL
ADDITIONAL ACADEMY SHIRTS CAN BE PURCHASED FOR $20 EACH (ADD $2 FOR SIZES 2XL OR LARGER PER SHIRT)
ADDITIONAL SHIRT: YS YM YL YXL AS AM AL AXL AXXL AXXXL
LIMITED SPACE – REGISTER ONLINE TODAY TO RESERVE YOUR SPOT HERE: LoperCamps.com
Call John Maessner at 308 870 0592 for more information or you can email me your registration & waiver and bring payment on day of camp. Or
mail registration, waiver and payment to : John Maessner – 2501 15th Ave – Kearney, NE 68849 (if you are bringing payment with you to camp,
please email me to reserve your spot) Please make checks payable to UNK SOCCER ACADEMY – 2501 15TH Ave, Kearney, NE 68849. All players must fill out the
UNKNSA Waiver and Registration before participating! Electronic Check Re-presentment Policy - In the event that your check is returned unpaid for insufficient or
uncollected funds, we may re-present your check electronically. In the ordinary course of business, your check will not be provided to you with your bank statement,
but a copy can be retrieved by contacting your financial institution. REFUND POLICY - UNK Soccer Camp Refunds are at the discretion of the camp director. If the camp
director determines that a refund will be awarded, there will be a $15 administrative fee subtracted from the refund total in addition to any online registration fee that
has been already charged. All refund checks will be mailed to the camper's home address that is supplied on their camp registration form and may take up to several
weeks to be processed.
UNK SOCCER ACADEMY
Soccer Camp @ Scottsbluff, NE – Boys & Girls
July 14th & 15th, 2015
Landers Soccer Complex
UNK SOCCER CAMP @ SCOTTSBLUFF, NE INFORMATION:
DO YOU WANT TO GET BETTER FAST? COME TRAIN WITH UNK COACHES AND PLAYERS!
UNK SOCCER CAMP @ SCOTTSBLUFF – Boys and Girls
July 14th & 15th, 2015 @ Landers Soccer Complex - $55
Includes UNK Soccer Academy T-shirt
June 14th
4-6pm
U9-U12 – BOYS AND GIRLS
6-8pm
HIGH SCHOOL PLAYERS – BOYS AND GIRLS
th
June 15
8-10am
U9-U12
10-12pm
HIGH SCHOOL PLAYERS
LIMITED SPACE – REGISTER ONLINE TODAY TO RESERVE YOUR SPOT HERE: LoperCamps.com
-WHO: For serious players in our REGION who want to improve their overall soccer abilities!
BUILD PASSION/DESIRE/SKILL/TECHNIQUE/FITNESS/AGILITY/ENDURANCE/WORK ETHIC/CONFIDENCE/SELF ESTEEM!
-WHAT TO BRING: Bring soccer ball, Indoor/outdoor soccer shoes, water bottle and a competitive spirit to all training sessions!
-STAFF: TOP NOTCH INSTRUCTION FROM UNK COACHES AND PLAYERS!
-COST: $55 per player! Includes UNK Soccer Academy t-shirt! Checks must be made payable to UNK Soccer Academy. Electronic Check Re-presentment Policy - In
the event that your check is returned unpaid for insufficient or uncollected funds, we may re-present your check electronically. In the ordinary course of business,
your check will not be provided to you with your bank statement, but a copy can be retrieved by contacting your financial institution. REFUND POLICY: UNK Soccer
Camp Refunds are at the discretion of the camp director. If the camp director determines that a refund will be awarded, there will be a $15 administrative fee
subtracted from the refund total in addition to the online registration fee that has been already charged. All refund checks will be mailed to the camper's home
address that is supplied on their camp registration form and may take up to several weeks to be processed.
CAMP PHILOSOPHY: UNK Soccer Camps are designed for soccer players who are looking for a challenging, energetic atmosphere where they will be pushed to
reach their full potential through a positive environment that will encourage a strong work ethic and will build passion, confidence and self-esteem! We will focus on
teaching proper technique, tactical awareness, game situations, agility, core strength, coordination, balance and will reinforce the importance of enjoying the game of
soccer!
MESSAGE FROM COACH MAESSNER: “Our camps are great for all levels – from beginners to advanced players! Each player will get an authentic UNK Soccer
experience, where they will learn from and work with UNK Coaches and Players. I look forward to working with the young players of our region and passing on the
knowledge of this wonderful game that I have been blessed to have been able to play and teach for over 38 years!”
-LIMITED SPACE, RESERVE YOUR SPOT TODAY! ALL PLAYERS MUST SIGN AND SUBMIT WAIVER, REGISTRAION AND PAYMENT BEFORE PARTICIPATING.
LoperCamps.com - Reserve your spot ONLINE today!
WAIVER & RELEASE AGREEMENT
UNK Soccer Academy
Upon acceptance of the attached application, I hereby waiver and release any and all rights and claims for damages I may have against
the Board of Regents of the University of Nebraska and all its employees and agents on account of any injuries or illness sustained by
myself or my child while attending camp/clinic/tournament. I authorize the director of the camp/clinic or his/her designee to select
hospital facilities and/or physician of his/her choice and authorize treatment on an emergency basis in the event such treatment
becomes necessary as a result of participation in the UNK Soccer Academy.
Date: _____/_____ /_______
Participant Name: ___________________________________________________
Signature: ____________________________________________________________________
If participant is under 19 years old, this form must be signed by the participant’s parent or legal guardian.
Date: ____/____/______
Parent/Guardian Name (Print): __________________________________________________
Parent/Guardian Signature: _____________________________________________________
MEDICAL INSURANCE: All participants of the UNK Soccer Academy will be required to have a signed
waiver and release agreement on file before participating. An athletic trainer will be on duty throughout the
entire camp/clinic. All participants should be covered by personal medical insurance. Each participant is asked
to provide the company name, company address, policy number, and the name of the policy owner. The
accident insurance provided by the camp/clinic is on a secondary basis.
Insurance Company Name: ______________________________
Policy Number: _______________________
Policy Owner Name: _____________________________
Please list any medical conditions or medications that participant is taking that we should be aware of:
__________________________________________________________________________________________
Additional Notes:
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