Age __________ q Male q Female
Mid-Central Conference Champions – 18 times NAIA District 21 Champions – 3 times NAIA Regional VIII Champions – once NAIA Men’s Soccer National Championship – 4 times NAIA Academic All-Americans – 70 and counting
PAID
Permit 71 Goshen, IN 46526
Name ______________________________________________________
Nonprofit Organization U.S. Postage
GOSHEN COLLEGE SOCCER CAMP 2012 APPLICATION
Address _____________________________________________________ City ________________________ State _______ ZIP code _____________ Phone ______________________________________________________ Current grade (as of Jan. 1, 2012) ______ Date of birth __________________ T-shirt size: q Youth M q Youth L q Adult S
q Adult M
q Adult L
q Adult XL
Are you interested in goalkeeper training?
q Yes
q No
Acknowledgment of risk and assumption of personal responsibility: I understand that during my participation in Goshen College Soccer Camp I will be exposed to above-normal risk. I understand, too, that although Goshen College and soccer camp personnel will take precautions to provide a safe environment, it is impossible to guarantee absolute safety. Also, I understand that I share responsibility for safety in the camp setting, and I assume that responsibility. I agree to verify with my physician that I have no physical or psychological problem that would prohibit participation in Goshen College Soccer Camp. I agree to comply with the instructions and directions of all camp directors and supervisors.
2012 GOSHEN COLLEGE
I have read the above statement and understand the nature of the physical demands of this activity. I therefore release any and all rights or claims for damages against Goshen College and camp personnel. Participant signature ___________________________ Date __________
Mail completed application to: Goshen College Soccer Camp / Att: Tavi 1700 South Main Street Goshen, IN 46526-4794 A deposit of $50 must be sent with the application. The remaining fee must be paid by June 19, 2012. Make check or money order payable to Goshen College Soccer Camp. Registration after June 19 is $200.
1700 South Main Street Goshen, IN 46526
Parent/guardian signature _______________________ Date __________
SOCCER CAMP JUNE 19-23