Vanderbilt Soccer Academy
(Boy's)

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 ______________________