Print out application for use.
Name: ____________________________________________
Address: __________________________________________
City/State/Zip: ______________________________________
Home Phone: ______________________________________
Emergency Phone: __________________________________
Parent/Guardian Name: ______________________________
Date of Birth: _______________
Age: _________
Grade (In Fall of 2003): __________________
Contact E-mail Address: ________________________________
Roommate Preference: _________________________________
(Resident campers can request a roommate or will be assigned one.)
Player Information: Select One
Field Player:
Goalkeeper:
Discounts
* Team/Group Name: _______________________
A $20 discount per person is available for teams or groups of eight or more
campers. (All applications must be sent in together in order to receive discount!)
* Family: A $20 discount is available for additional family members who attend!
* Vanderbilt University Faculty or Staff Member:
A $20 discount per person is available for the son of a VU faculty or staff
member!
(Please contact Soccer Office)
Deposits
Day Camp: A $50 nonrefundable deposit must accompany your application to reserve your space for the Day Camp. Advanced or Elite Camp: A $100 nonrefundable deposit must accompany your application to reserve your space for the Advanced or Elite Camp.
Please Check Camp of Your Choice
Half Day Camp: June 23-27; $135 (Ages 5-10)
Half Day Camp: July 7-11; $135 (Ages 5-10)
Half Day Camp: July 14-18; $135 (Ages 5-10)
Day Camp: July 7-11; $225 (Ages 10-15)
Day Camp: July 14-18; $225 (Ages 10-15)
Advanced Camp: July 20-24; $435 - Resident (Ages 10-18)
Advanced Camp: July 20-24; $335 - Commuter (Ages 10-18)
Elite Camp: July 20-24; $485 - Resident (Ages 13-18)
Elite Camp: July 20-24; $385 - Commuter (Ages 13-18)
Soccer Ball and Camp T-Shirt will be included in the cost of the camp tuition.
Ball Size: Please check one!
I would like a size 4 ball (Size recommended for players who are under 12 years
old).
I would like a size 5 ball (Size recommended for players who are over 12 years
old)
T-Shirt Size: Please check one!
*Youth (small
, medium
, large
)
* Adult (small
, medium
, large
, x-large
)
Airport Shuttle Service: Please check if you need shuttle service form the
airport!
* I will need shuttle service ($20 fee) _____
Please contact Tim McClements in the Vanderbilt Soccer Office with your flight information.
Return completed application form and camp deposit (payable to Vanderbilt Soccer Academy) to:
Vanderbilt Athletics
Dept. AT 40459
Atlanta, GA 31192-0459
(Vanderbilt finances through a bank in Atlanta, GA)
Any questions regarding the Vanderbilt Soccer Academy, please contact:
Tim McClements (Vanderbilt Soccer Academy Director)
Phone: (615) 343-8098
Email: tim.mcclements@vanderbilt.edu
Release From Liability
Vanderbilt Soccer Academy
Vanderbilt University will be sponsoring the Vanderbilt Soccer Academy (Boy's),
a summer camp on campus in Nashville, Tenn. At the camp, players will be participating
in soccer skill activities and games.
I would like for my child, _________________________, who is _____ years of
age, to participate in the Vanderbilt Soccer Academy (Boy's) camp and I consent
to such participation.
I recognize and understand that I am allowing my child to participate in this
camp voluntarily, that the camp is optional and that my child may be exposed
to some level of risk of injury during camp.
Furthermore, in consideration of Vanderbilt University allowing my child to
participate in this camp, I hereby do release and hold harmless Vanderbilt and
its trustees, agents, officers, servants and employees against loss (including
reasonable attorneys' fees) from any and all claims, or causes of action of
any kind or nature that may be brought by or on behalf of me or my child arising
out of any and all known or unknown, foreseen and unforeseen bodily or personal
injuries, damages to property and consequences thereof which may be sustained
by me arising out of or in connection with my child's participation in this
camp, except such liability or claim of liability as may result from gross negligence
on the part of Vanderbilt University.
I hereby give permission for the medical staff at Vanderbilt to perform such
diagnostic, therapeutic, and operative procedures as they deem necessary for
my child. My son has had a recent physical and it is fit according to our physician
to participate in the Vanderbilt Soccer Academy (Boy's). I understand the camp
is not responsible for medical expenses incurred as a result of personal injury
while participating in the Vanderbilt Soccer Academy (Boy's).
I have read the foregoing release and understand that I am signing a complete
release and bar to any claims as defined above.
Date__________
Signature______________________________
Witness_______________________________
Insurance Company ______________________