The Chargers Development Academy Staff will be hosting summer camps from June 5-9th, July 10-14th, July 17-21st. The cam
Chargers DA Elite Soccer Camps Camps will be hosted at Clearwater Campuses The Chargers Development Academy Staff will be hosting summer camps from June 5-9th, July 10-14th, July 17-21st. The camp will consist of technical, tactical training and small sided games to enhance the individual technique, tactical understanding, and mental components of the game for each player.
Dates and times June 5-9th, July 10-14th and July 17-21st. 9:00 A.M. to 12:00 P.M. for boys and girls 3 different age divisions: 8-10, 11-14, 15-19 years old.
Registration and Player information Camp Dates: _______________________________________ Player Name: _______________________________________ Parent Name: _______________________________________ Email Address: ______________________________________ Phone #: ___________________________________________ Age: ___________________ Gender: _________ Position normally plays on field: _______________________
Emergency Contact Name: ________________________ Phone #: ___________________________ Relationship to Participant: ________________________________
Cost: $ 175.00 before May 16th and $200 after May 16th. Please make check out to Chargers SC and mail it to: Chargers SC P.O. Box 47026 Tampa, FL 33646 *Registration Forms should be emailed electronically to
[email protected]. If you have any questions you can reach Nathan Bender at
[email protected], bring your own soccer ball, packed snacks, and water. Chargers SC and Nathan Bender are not to be held responsible for lost balls and cannot be held liable for any injuries that occurred during camp training.
Parent Signature ___________________________
Date _______________
Agreement of Release and Waiver of Liability
I, _________________________________________________hereby agree to the following: 1. That my child is participating in the soccer camps or health programs offered by Chargers SC and Nathan Bender, during which I will receive information and instruction about soccer, nutrition, and/or health. I recognize that soccer requires physical exertion, which may be strenuous and may cause physical injury, and I am fully aware of the risks and hazards involved. 2. I understand that it is my responsibility to consult a physician prior to and regarding my child’s participation in the soccer camps offered by Chargers SC Nathan Bender and Blake Wagner. I represent and warrant that my child is physically fit and has no medical condition, which would prevent him/her from full participation in these soccer camps. 3. In consideration of being permitted to participate in the soccer camps, I agree to assume full responsibility for any risks, injuries, or damages, known or unknown, which my child might incur because of participating in the programs(s) offered by Chargers SC and Nathan Bender. Permission is granted for my child to receive emergency medical treatment if needed and I certify that there are no limits to my child’s participation except as stated in writing and included with this application form. 4. In further consideration of being permitted to participate in the soccer camps, I knowingly, voluntarily, and expressly waive any claim I may have against Nathan Bender, Chargers SC and Pepsi Co. for injury, death, or damages that I may sustain because of participating in these programs. 5. I understand that from time to time during soccer camps, the instructor may physically adjust students’ form and posture. If I do not want such physical adjustments to my child, I will so inform the instructor at the beginning of the camp they attend. I also acknowledge that if I do wish for my child to receive such adjustments, it is my responsibility to inform the instructor when an adjustment has gone as far as I desire at that time. 6. I, my heirs or legal representatives forever release, waive, discharge and covenant not to sue Nathan Bender, Chargers SC and Pepsi Co. for any injury or death caused by their negligence or other acts. 7. I, my heirs or legal representatives forever release, waive, discharge and covenant not to sue any location Chargers SC and Nathan Bender uses for exercises or events or for any injury or death caused by their negligence or other acts. 8. I have read the above release and waiver of liability and fully understand its contents. I voluntarily agree to the terms and conditions stated above.
As Legal Guardian of _______________________________, I consent to the above.
___________________________________
____________
Signature of Parent/Guardian of Participant
Date
Our instructors promise to keep all the above information confidential. Thank you for being a part of the Chargers DA Elite Summer Camps.
