Mountain State University/ YMCA

4th Annual Age Group

Summer Soccer Camps

2008

*Minimum Camper Age is 7 Years Old

ABOUT THE CAMP DIRECTOR

For the fourth consecutive year, John Birkelbach, Head Men’s Soccer Coach for Mountain State University, will conduct age group soccer camps for our local players.  John played for Coach Rocky Powell at Woodrow Wilson High School, where he earned All-State honors and two final four appearances plus one state final appearance in the WVSSAC State High School Soccer Tournament.  John continued his soccer career at the collegiate level at the University of Charleston.  He was a four year starter and a member of the 1999 UC team that reached the NCAA Division II Final Four.  Upon graduating in 2001, John became an assistant coach for UC, where, over the next three seasons, he completed his Master’s Degree in Business and helped coach the team to the 2004 WVIAC Tournament Championship.  He furthered his playing career as a member of the West Virginia Chaos, a semi-pro team headquartered in Charleston, where he spent two seasons.  In 2005, John accepted the head coaching position at Bluefield College and, in his first season, guided the team to the United States Collegiate Athletic Association National Championship.  In 2006, John came home to Beckley to start the men’s soccer program at Mountain State University.  Currently, he is the Head Men’s Soccer Coach at MSU and is the Coaching Director for the West Virginia Rapids Soccer Club.

ABOUT THE CAMP

Camp counselors will include current Mountain State University soccer players and former collegiate soccer players.  The camps are designed to improve each camper’s individual skill with each session focusing on the fundamentals of the game – dribbling, passing, trapping, heading, and shooting.  At the end of each session, campers will have the opportunity to work on their new skills through scrimmages. These are the basic building blocks upon which your child can become the best that he/she can be while playing soccer.

Mail Completed Registration Form to:

Beckley/Raleigh County YMCA Soccer Camp

121 East Main St.

Beckley, WV 25801

Camper Information

Camper Name_________________________________ Age_________

Grade______    School________________________________________

Address___________________________________________________

Phone (day) ________________ (evening) ________________________

Parents Name_______________________________________________

Emergency Contact Name_____________________Phone___________

Please note below any of your child’s allergies or medical conditions that

camp staff should be aware of :

__________________________________________________________

__________________________________________________________

__________________________________________________________

Special medical needs (if any)__________________________________

__________________________________________________________

Medical Insurance Information

Insurance Company Name____________________    Policy#____________

Policy Holder’s Name_______________________     Exp. Date__________

Physician’s Name___________________________    Phone_____________

Hospital_____________________________________________________

Medical Waiver

As the Parent/Legal Guardian of the above camper, I hereby give my permission for him/her to participate in the 2008 Mountain State University YMCA 4th Annual Age Groups Summer Soccer Camp.  I attest that he/she is physically capable of participating in this camp.  I understand that Mountain State University, the Beckley-Raleigh County YMCA and the Camp Director & Instructors do not have medical insurance, and, thereby, release them of any liability resulting from injuries sustained by my child during camp activities.  Further, I authorize the camp staff to act on my behalf in any emergency situation involving my child.

Signature of parent/guardian___________________________________

For office use only:

Membership #________________       Expiration_______________       Rec’d___________

Check #________________                   Amount_____________