Edinboro University Soccer Camp Medical & Insurance Information Women’s ID Camp The hospital requests that we have insurance informa- tion available as well as your name and phone number. In the event you are not available for parental consent, The hospital medical staff may proceed with medical treatment. INSURANCE COMPANY ___________________________________________ POLICY NUMBER Please indicate any medical concerns we should be aware of: Read and sign the following release: We, the undersigned parent(s) and or legal guardian(s) of a camp participant under the age of 21 years, do herby agree that he or she may participate in the Edinboro University Soccer Camp. In consideration that he or she has been accepted by the Edinboro University Camp for instructions we do fur- ther agree for and on behalf of him or her and for ours- elves individually that we will assume all risks associated with any portion of the camp including traveling to and participating in activities while on campus. In coopera- tion with such course of instruction we will bind Edin- boro University and the enacting staff harmless against all claims for damage to person or property while trave- ling or participating in this activity on campus. SIGNATURE OF PARENT/GUARDIAN ____________________________DATE:__________ July 10 - 13, 2019 7/10 – Check In – 12:30 pm 7/13 – Check Out – 11:00 am Edinboro University of Pennsylvania Sample Daily Schedule 7:30-8:30 9:00-11:00 12:00-1:45 2:00-4:00 4:45-6:00 6:30-8:15 9:00-10:30 10:30 Breakfast Team Training Lunch Dinner Scheduled Games Match Day Analysis Lights Out Women’s ID Camp **Bring swimsuits for swimming facilities** July 10 - 13, 2019 3 Games Guaranteed Evaluation at the End of Camp “Technical, Tactical, and Mental Total Player Development” All teams will have certified USSF or NSCAA coaches. Every day will end with match analysis with the respective coach.

Edinboro Soccer Camp Application Camp Staff Camp Philosophy Registration The Edinboro Soccer Camp is designed to make you a better player. You will be schooled in ways to not only train with your team, but also in ways to train on your own. Our staff of international and collegiate coaches offer you intense individual technical training. The skills you will learn at each training session can immediately be put to use in the small-sided games. You are encouraged to try what you have learned. As well as contributing to the local community, our goal at Edinboro University is to offer quality personal instruc- tions to youth players at an affordable price so every player has the ability and facilities to improve their soccer skills. $340 per camper for Highlands Dorms *A goalkeeping coach will be present to work exclusively with the goalkeepers daily* To reserve a place in residential camp, send this application form back in the mail along with payment. Mail to: P.O. Box 355, Edinboro, PA 16441 Gary Kagiavas Head Women’s Coach – Edinboro University Former Assistant Coach – Gannon University Two-time PSAC Coach of the Year Former Professional Player USSF & South African Coaching Licenses MSA Coaching Director Erie Premier Sports Camp Director Rene Lawrence Head Women’s Coach – Lake Erie College Youth Club Coach – Whitecaps Soccer Club Bill Pfeiffer PA West ODP Staff Coach Head Women’s Coach – Moon Area High School Youth Club Coach Chet Gapzynski Region 1 ODP Staff Coach Director of Coaching – FC Pittsburgh Jamie Sallie Assistant Women’s Coach – Edinboro University Youth Club Coach – MSA Buddy Cooper Assistant Women’s Coach – Lake Erie College Youth Club Coach-Excalibur Soccer Club Edinboro Soccer Camp Application Facilities Name __________________________________ Address ________________________________ City _______________ State ___ Zip ________ Date of Birth ____________________________ Grad Year ______________________________ Parent/Guardian __________________________ Cell Phone ______________________________ Email___________________________________ Edinboro University features recreational facilities such as an AAU-size pool, basketball complete gymnasium, racquetball, sand volleyball, bookstore, and convenient store and bank. Teams will stay in the new, state of the art Highlands dormitories. Rooms are 4 players per room and include air-conditioning. Each player is responsible for bringing their own sheets, towels, and toiletries. The University is only 18 miles south of Erie and 100 miles from the cultural centers of Pittsburgh, Cleveland, and Buffalo. When traveling north or south on I-79, take the Edinboro exit and follow RT. 6N to Edinboro. Please check your choice ___ Field player ___ Goalkeeper ___ I am purchasing the camp ball (Please enclose payment of $25 for the ball with your application) ___ I will bring my own ball For additional information, contact: Gary Kagiavas 814-732-1876 Please circle your t-shirt size S M L XL