2013 SoccerSummer Camps

Join us August 5th thru August 8th, for the 2013 Humboldt State Soccer Summer Camps. Team camp dates are o� ered August 19th thru August 22nd. The HSU coaching sta� & players will be hosting the three camps for athletes ages 5 to 14 years old. These camps are designed for boys & girls of all skill levels and are a perfect way to improve skills & aquire others that will take your game to the next level!

KIDS CAMP: The Kids camp is for kids ages 5 to 8 years old. Each camper will participate in one training session per day. The focus will be on the fundementals of soccer and having fun!! Monday - Thursday 9 a.m. to 11:30 a.m. (Session #1) $100 per athlete Camp Code #: NST-ATH J163

YOUTH CAMP: The Youth Camp is for kids ages 9 to 14 years old. Each camper will participate in two training sessions per day. The focus of the morning session (#1) will be on the development of the athletes technical skills. The afternoon session (#2) will concentrate on tactical development through small-sided games. Monday - Thursday 9 a.m. to 11:30 a.m. (Session #1) 11:30 a.m. to 12:30 p.m. Lunch/Break (campers must provide their own lunch) LUNCH WILL BE SUPERVISED 12:30 p.m. to 3 p.m. (Session #2) $150 per athlete Camp Code #: NST-ATH J164

TEAM CAMP: This camp is designed for teams to train together. The focus is working with each team’s individual coach to make sure that their athletes are ready for competition heading into their league season. To register a team,Contact the HSU Coaches directly at the email addresses listed. *Monday - Thursday (August 12th-August 15th) 9 a.m. -12 p.m. or 3:00 p.m. - 6 p.m. Camp Code #: NST-ATH J162 $1,250 per team. An average of $78 per player

To register - Enrollment Application, Wavier, and a $50 deposit are required. Blance is due the ¤ rst day of camp. Please return all forms along with your deposit to address listed below: HSU Student Financial Services 1 Harpst Street Arcata, CA 95521 (Make checks payable to Humboldt State University)

***Include Proper Camp Code***OR

Register ONLINE at www.HSUJacks.com

Camp Location - HSU College Creek Soccer Field.

Contact Colin Caron @ccg3@humboldt.edu

Contact Christian Johnson @ christian.johnson@humboldt.edu

ENROLLMENT APPLICATION:Player Name:

Player D.O.B:

Email:

Phone:

Address:

City/State/Zip:

T-Shirt Size: YS - YM - YL - YXL - AS - AM - AL Camp Code:______________

2013 Soccer Camp August 5th - AUGUST 8th

ASSU

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aiver is a contract with legal consequences. R

ead it carefully before signing! If there are any questions concerning this docum

ent, contact the sport cam

p coordinator. In consideration of my son/daughter to participate in the Soccer

Sport Cam

p, I hereby freely agree to make the follow

ing contractual agreements: In

agreeing to allow m

y son/daughter to participate in the Soccer Sport Cam

p at Hum

boldt State U

niversity, I am aw

are and knowledgeable of the risks of this activity, and other

risks and dangers which m

ay occur, including but not limited to hazards of travel, acts

of God, accident, illness, physical and/or psychological injury, property loss, tem

porary or perm

anent disability, or even death. I understand and agree that my son/daughter m

ay be in situations that m

ay arise during an activity which m

ay be beyond control. I fully realize the dangers of m

y son/daughter participating in an activity of this type and vol-untarily assum

e all the risks associated with such participation. In consideration of m

y son/daughter’s acceptance as a participant in such sport cam

p, I hereby release, forever discharge and agree to hold harm

less the State of California, C

alifornia State University,

Hum

boldt State University, R

edwood C

onference Center, Lum

berjack Enterprises, its offi cers, em

ployees and agents from any and all liability, claim

s, suits or damages,

including attorney’s fees resulting from m

y son/daughter’s participation in the sport cam

p. This contract shall serve to indemnify the above nam

ed parties should the same be

liable or found negligent as a result of any court action arising from m

y son/daughter’s participation in the Soccer Sport C

amp.

I HAV

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UN

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ental dem

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ind, to my

knowledge, m

y son/daughter, does not have a physical or medical condition w

hich w

ould endanger him/her or others due to his/her participation in this activity, or w

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umboldt State U

niversity has not made, nor w

ill make any investigation

into the participant’s physical fi tness or the ability of the participant to participate in the activity and is relying on m

y representation concerning the participant’s physical and m

ental condition. I also agree that my son/daughter w

ill abide by any established rules or regulations w

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AVE R

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(INITIA

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amp at H

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niversity. Furthermore, in

the event of accident or illness of an emergency nature, and because I m

ay be unable to select or approve of the required m

edical treatment, I do hereby authorize the organiza-

tion’s offi cers, event organizers or representatives of HSU

to arrange for such care as is available and necessary: and do further release and forever discharge the providers of such care and the State of C

alifornia, California State U

niversity, Hum

boldt State U

niversity, Redw

ood Conference C

enter, Lumberjack Enterprises, its offi cers, em

ploy-ers and agents from

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(INITIA

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E) _____Please list any physical disabilities, conditions, past injuries or any other physical lim

ita-tions w

hich could limit your son/daughter’s participation in any w

ay. (If there is any doubt w

hatsoever about your child’s ability to safely participate in this activity, he/she should have a physical exam

ination by a physician).Please list any allergies or m

edical alert information: ____________________________

_________________________________________________________________________________________________________H

ome phone: ____________________ W

ork phone:____________________Insurance C

arrier: ________________________________________________________Policy #: ____________________________________________________________I am

aware that H

umboldt State U

niversity does not provide medical insurance coverage

and therefore take full responsibility for my child’s m

edical insurance and/or costs of m

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hich might result

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y responsibility.I H

AVE R

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AN

D U

ND

ERSTA

ND

(INITIA

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E) _____I have carefully read this form

and understand its contents. I am aw

are this is an as-sum

ption of risk, a health statement and a liability w

aiver. It is an agreement not to sue

for negligence and a contract between m

yself and the Soccer Sport Cam

p. I also hereby acknow

ledge that this agreement shall be governed and construed in accordance w

ith C

alifornia law and each party hereby irrevocably subm

its to the exclusive jurisdiction and service of process of the C

alifornia courts. I further acknowledge that I am

18 years or older and am

the parent or legal guardian of the participant for the benefi t of others described herein. I sign it of m

y own free w

ill.I H

AVE R

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AN

D U

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(INITIA

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E) _____Participant’s nam

e_____________________________________________________Parent/G

uardian signature ___________________________ Date _______________

Participant’s signature (if over 18) _____________________ Date _______________

HSU Soccer Humboldt State University1 Harpst Street, Arcata, Ca. 95521

Enrollment Application

ASSUMPTION OF RISK/HEALTH STATEMENT/LIABILITY WAIVERNOTICE: This waiver is a contract with legal consequences. Read it carefully before signing! If there are any questions concerning thisdocument, contact the sport camp coordinator.In consideration of my son/daughter to participate in the Soccer Sport Camp, I hereby freely agree to make the following contractual agreements: Inagreeing to allow my son/daughter to participate in the Soccer Sport Camp at Humboldt State University, I am aware and knowledgeable of the risksof this activity, and other risks and dangers which may occur, including but not limited to hazards of travel, acts of God, accident, illness, physicaland/or psychological injury, property loss, temporary or permanent disability, or even death. I understand and agree that my son/daughter may be insituations that may arise during an activity which may be beyond control. I fully realize the dangers of my son/daughter participating in an activityof this type and voluntarily assume all the risks associated with such participation. In consideration of my son/daughter’s acceptance as a participantin such sport camp, I hereby release, forever discharge and agree to hold harmless the State of California, California State University, HumboldtState University, Redwood Conference Center, Lumberjack Enterprises, its offi cers, employees and agents from any and all liability, claims, suits ordamages, including attorney’s fees resulting from my son/daughter’s participation in the sport camp. This contract shall serve to indemnify the abovenamed parties should the same be liable or found negligent as a result of any court action arising from my son/daughter’s participation in the SoccerSport Camp.I HAVE READ AND UNDERSTAND (INITIAL HERE) _____I agree that it is my sole responsibility to be familiar with the physical and/or mental demands associated with the above named camp. With thesedemands in mind, to my knowledge, my son/daughter, does not have a physical or medical condition which would endanger him/her or others dueto his/her participation in this activity, or would interfere with his/her ability to participate in the activity. I understand that the Soccer Sport Campat Humboldt State University has not made, nor will make any investigation into the participant’s physical fi tness or the ability of the participant toparticipate in the activity and is relying on my representation concerning the participant’s physical and mental condition. I also agree that my son/daughter will abide by any established rules or regulations while participating in this activity.I HAVE READ AND UNDERSTAND (INITIAL HERE) _____I hereby declare that my son/daughter is physically capable to be a member of and participate in the Soccer Sport Camp at Humboldt State Univer-sity.Furthermore, in the event of accident or illness of an emergency nature, and because I may be unable to select or approve of the required medicaltreatment, I do hereby authorize the organization’s offi cers, event organizers or representatives of HSU to arrange for such care as is available andnecessary: and do further release and forever discharge the providers of such care and the State of California, California State University, HumboldtState University, Redwood Conference Center, Lumberjack Enterprises, its offi cers, employers and agents from any and all claims, demands andcauses of action arising out of said authorization.I HAVE READ AND UNDERSTAND (INITIAL HERE) _____Please list any physical disabilities, conditions, past injuries or any other physical limitations which could limit your son/daughter’s participation inany way. (If there is any doubt whatsoever about your child’s ability to safely participate in this activity, he/she should have a physical examinationby a physician).Please list any allergies or medical alert information: _____________________________________________________________________________________________________________________________________________________________________________In case of emergency notify: ___________________________________________Home phone: ____________________ Work phone:____________________Insurance Carrier: ________________________________________________________________Policy #: ____________________________________________________________I am aware that Humboldt State University does not provide medical insurance coverage and therefore take full responsibility for my child’s medicalinsurance and/or costs of medical treatment. I understand that all expenses, charges, or costs which might result from injury or illness are fully myresponsibility.I HAVE READ AND UNDERSTAND (INITIAL HERE) _____I have carefully read this form and understand its contents. I am aware this is an assumption of risk, a health statement and a liability waiver. It is anagreement not to sue for negligence and a contract between myself and the Soccer Sport Camp. I also hereby acknowledge that this agreement shallbe governed and construed in accordance with California law and each party hereby irrevocably submits to the exclusive jurisdiction and service ofprocess of the California courts. I further acknowledge that I am 18 years or older and am the parent or legal guardian of the participant for the benefi t of others described herein. I sign it of my own free will.I HAVE READ AND UNDERSTAND (INITIAL HERE) _____Participant’s name_____________________________________________________Parent/Guardian signature ___________________________ Date _______________Participant’s signature (if over 18) _____________________ Date _______________

Participant’s Name: Age:

Address: Email:

City/State/Zip: Club Team:

Phone: Parent’s Name:

NST-ATH J163

Insurance Carrier: ________________________________________________________________Policy #: ____________________________________________________________I am aware that Humboldt State University does not provide medical insurance coverage and therefore take full responsibility for my child’s medicalinsurance and/or costs of medical treatment. I understand that all expenses, charges, or costs which might result from injury or illness are fully myresponsibility.I HAVE READ AND UNDERSTAND (INITIAL HERE) _____I have carefully read this form and understand its contents. I am aware this is an assumption of risk, a health statement and a liability waiver. It is anagreement not to sue for negligence and a contract between myself and the Soccer Sport Camp. I also hereby acknowledge that this agreement shallbe governed and construed in accordance with California law and each party hereby irrevocably submits to the exclusive jurisdiction and service ofprocess of the California courts. I further acknowledge that I am 18 years or older and am the parent or legal guardian of the participant for the benefi t of others described herein. I sign it of my own free will.I HAVE READ AND UNDERSTAND (INITIAL HERE) _____Participant’s name_____________________________________________________Parent/Guardian signature ___________________________ Date _______________Participant’s signature (if over 18) _____________________ Date _______________

2013 Soccer Camp August 5th - AUGUST 8th