4:30-5:00 pm    Registration

5:00-5:10 pm    Opening Ceremonies

5:10-5:30 pm    Foot skills and juggling-warm up and stretching

5:30-7:30 pm    Stations- Finishing, defending, coervers and 1v1s, possession, passing                            and receiving, long balls and receiving air balls.  

7:30-7:50 pm                Small Sided Games

7:50-8 pm                     Closing Ceremonies

Cost: $25.00 Donation

You must bring: Water bottle, shin guards, and cleats.

Any questions please contact Coach Jess Reynolds at 610-660-3367 or email jreynold@sju.edu

Please complete and mail along with the check to:

City 6 Soccer Clinic

Attn: Jess Reynolds

Saint Josephs University

5600 City Avenue

Philadelphia, Pennsylvania 19131-1395

Please make all checks payable to Childrens Hospital of Philadelphia.

Thanks for your support!

Name:_________________________     Age:_______     Grade:_______

Street:______________________________________________________________

City:___________________________     State:___________     Zip:__________

Phone Number:___________________     Email:___________________

Shirt Size: Please circle.  Youth   S   M   L     Adult    S   M   L     Position:________________

Soccer Experience:______________________________________________________

Waiver Form

Since all campers will be under the age of 18, this waiver must be signed by the childs parent or guardian.

Statement

I understand City 6 Soccer, its staff and employees, and the City 6 Soccer clinic staff are not responsible for any accident or injury occurring to(child)____________________while attending camp

____________________

Parent/Guardian Signature

Please list any pertinent medical information of which our staff should have knowledge.

Authorization to consent to medical treatment for a minor child

I, (parent/guardian)____________________, state that I am the natural parent and/or have legal custody of(childs name)____________________.

I authorize ____________________ head coach and clinic director, to consent to any examination, anesthetic, xray, medical or surgical diagnosis or treatment, and/or hospital care to be rendered to this minor under the general conditions of special supervision and on the advice of any physician or surgeon licensed to practice when efforts to contact me are unsuccessful.  This consent form is granted for the period of______________________.

Parent/ Guardian Name:_____________________________________

Parent/ Guardian Signature:__________________________________

Date:________________   Emergency Phone Number:___________________________

Medical Insurance Carrier_________________________________________________

Insurance ID #_____________________  Carrier Phone #________________________