Enrollment Form

ENROLLMENT FORM CURRICULUM COST Name: ______Technical Training $190.00 Per Individual for One Week Dribbling The full amount is required with each enrollment form. Street: ______body swerves + feinting, dribbling with speed, dribbling with a purpose 2016 City: ______Passing State: ______Zip Code: ______deceptive techniques, bending & swerving the ball, precision through balls CAPE COD

Home Phone: ______Shooting scoring off one touch, from different angles, curving the Emergency/Cell: ______ball around the goalkeeper with both sides of the foot

E-Mail (Required): ______Receiving re-directing first touch away from pressure, turning Date of Birth: ______techniques, different body parts SOCCER ACADEMY, Inc.

Age at First Day of Camp: ______Tactical Training Grade Entering August/September 2016: ______Attacking Principles DAY CAMP FOR: penetration, depth, width, movement off the ball, Boys & Girls Parent’s Name: ______creating channels for teammates 1st to 8th Graders 9:00 a.m. – 3:30 p.m. Other Family Member(s) Attending Camp:______Defending Principles Goalkeeper Training pressure-angle + speed of approach, contain, cover, (for 5th to 8th Graders) staying compact, communicating Please Circle:

Field Player Goalkeeper LOCATION: Upper Cape Cod Tech High School Boy Girl Bourne, Massachusetts

T-Shirt Size: Youth S M L or Adult M L XL

ACADEMY OFFERINGS DATES: August 1 – August 5, 2016 Parent’s Signature Date Awards Camp T-Shirt $190.00 (no partial deposit will be accepted) please make check payable to: CAPE COD SOCCER ACADEMY Beautiful Grass Fields ______mail completed enrollment form, both sides, to: Certified Athletic Trainer Specialized Goalkeeper Training SOCCER Cape Cod Soccer Academy, Inc. Appropriate Staff to Student Ratio Live Post Office Box 973 Passing, Dribbling, Scoring, PK Contests It Forestdale, MA 02644

Plyometric Training for 5th – 8th Love Graders It ______where he was selected to the Old Colony League All-Star team in his senior year as he was the team’s second leading goal scorer in the fall of 1987. He also played two seasons for FC Luis de Camoes in Stoughton in the second division of the then Additional Information: popular Luso American Soccer Association. Tony Reis – Director [email protected] IMPORTANT NOTES ACADEMY DIRECTOR THE PROGRAM *Each student needs to bring their own lunch daily. *Each student must wear shin guards, have their Full Day Grade Tony Reis own soccer ball (size appropriate) and their own Entering Coach Reis completed his third year as the head coach of the beverages.

Upper Cape Cod Tech High School Boys Soccer team in 2015. Pee-Wee Stars: 1st + 2nd *CAPE COD SOCCER ACADEMY is not responsible They have qualified for the Massachusetts Interscholastic Graders for any lost items. Athletic Association Division 4 state tournament all three Little Stars: 3rd + 4th *Every year, we perform CORI background checks years. Their best run was last year, as they lost in the second Graders on all staff + coaches as part of our hiring process. round of the tournament. UCT compiled a regular season Middle Stars: 5th + 6th record of 11 wins 4 losses 3 ties that same year; their best Graders ______mark out of the three campaigns under Reis. The Rams boys Big Stars: 7th + 8th squad have also won or shared the Mayflower Athletic Conference Small Division regular season championship three Graders SOCCER consecutive years. The team had their best defensive Live campaign in 2015 as they only allowed 16 goals in 22 total It matches, a 0.73 GAA, to go along with 12 shutouts. Since 2013, UCT has an accumulative league record of 14-2-2. Love It Coach Reis has the following coaching licenses: ______USSF F License

NSCAA Level 6 Diploma MIAA/MSSAA Certified Coach PARENTAL PERMISSION FORM NFHS Certified Interscholastic Coach NSCAA Goalkeeping Level 2 Diploma Daily Schedule I, the undersigned, hereby acknowledge and understand that the CAPE COD SOCCER ACADEMY 8:45 a.m. Arrival; Sign-In Currently, Reis is a certified referee since 1990 where he has is an independently owned sports camp and is not officiated United Stated Soccer Federation club and mens 9:15 a.m. Warm-Up (with your operated by or through Upper Cape Cod Technical league games along with working high school soccer matches team) High School in Bourne, Massachusetts. as a member of the Whaling City Soccer Officials Association 9:30 a.m. Technical Training for ten years. In 1996 he was one of 15 USSF Massachusetts I hereby authorize the staff of CAPE COD SOCCER referees chosen to officiate at the US Youth Region I 10:30 a.m. Small-Sided Games tournament in New York. He refereed the MIAA Division 3 high 11:30 a.m. Lunch – Inside Cafeteria ACADEMY to act for me according to their best school boys soccer state semi-final tournament game in 1999. judgement in any emergencies requiring medical 12:30 p.m. Warm-Up (with your team) He was the center official for the 2003 and 2005 New England attention and I hereby waiver and release the CAPE 12:45 p.m. Tactical Training Region Junior College mens soccer championship finals. He is COD SOCCER ACADEMY, its coaches, staff, director an active NCAA Division I II III mens and womens soccer 1:45 p.m. Fun Natured Contests and athletic trainer from any and all liability for any referee since 1995 for the National Intercollegiate Soccer Officials Association. He has worked numerous conference, 2:30 p.m. Small-Sided Games injuries or illnesses incurred while at camp. ECAC and NCAA tournament contests as a center referee and 3:30 p.m. Departure; Sign-Out as a linesman. (plenty of water breaks are spread out throughout the day) I have no knowledge of any physical impairment that would be affected by the camper name Reis played competitive futebol for 14 years at the youth, club, high school and amateur mens levels, mostly in Taunton. He herein’s participation in the camp program. played four years of club soccer for the Taunton Sports U19 team. He was a two year starter at Taunton High School, I also understand that the CAPE COD SOCCER ACADEMY provides only excess insurance coverage after my insurance policy has been utilized entirely.

All photographs taken at the camp may be used in future printed and electronic promotional sites.

The full amount of $190.00 is required with each completed enrollment form. Mailing the enrollment form only, does not constitute as acceptance. Please include a copy of Health and Immunization record with the enrollment form. Accepted applications will be sent a confirmation e- mail.

Insurance Provider: ______

Policy Number: ______

Signature: ______

Print Name: ______

Date: ______