Mountain State University/ YMCA

3rd Annual Age Groups

Summer Soccer Camps

2007

Date                       Age                           Time                         Cost

June 11th -15th               Ages 5-8                         6:30pm-9pm                   $125

June 18th – 22nd            Ages 9-12                       6:30pm -9pm                   $125

June 25th- 29th              Ages 13-15                     7pm – 10pm                    $150

John Birkelbach Head Men’s Soccer Coach for Mountain State University will be holding age group soccer camps for our local athletes. John played for Rocky Powell at Woodrow Wilson High School earning All-State honors and two final four appearances in the State High School Tournament. John continued his soccer career at the University of Charleston where he started all four years going to the NCAA Div. II Final Four in 1999. While receiving his Masters Degree from the University of Charleston he was assistant coach for the University of Charleston men’s soccer program. He continued his career with the WV Chaos, a semipro team from Charleston WV until taking the Head Soccer Coaching position at Bluefield College. Where in his first season won the United States Collegiate Athletic Association National Championship.  He started the men’s soccer program at Mountain State University in 2006.  Camp counselors will include current Mountain State University soccer players and former collegiate soccer players.

Sessions will be held to give each camper a better understanding of the skills needed to perform at their maximum ability. The camps will be designed to improve each campers individual skills focusing on dribbling, passing, trapping, heading, and shooting. At the end of each session small sided scrimmages will be employed to allow the participant to work on these new skills in game situations. These are the basic building blocks upon which your child can become the best that he/she can be while playing soccer.

Mail Registration to:

Beckley/Raleigh County YMCA Soccer Camp

121 East Main St.

Beckley, WV 25801

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 the 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

I, parent or legal guardian of ______________________, gives my permission for him/her to participate in the 2007 Mountain State University/ YMCA 3rd Annual Age Groups Summer Soccer Camp.  I attest that he/she is physically capable of participating in this camp.  I understand that neither the Mountain State University/Beckley-Raleigh County YMCA nor the Camp Director or instructors have medical insurance and  I release them of any liability resulting from injuries sustained by my child during camp activities, I further authorize the camp staff to act on my behalf in any emergency situation involving my child.

Signature of parent/guardian___________________________________

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For office use only:

Membership #________________Expiration_______________Rec’d___________

Check #________________ Amount_____________