! LE Charlotte Soccer Academy AB AIL BIRD AND AV SPECIALS! 2017 Summer Soccer Camp Series Application Y EARL Camper's Name _______________________________________________________________________________ DISCOUNT DISCOUNTSDISCOUNTS Shirt Size (circle) YS YM YL AS AM AL Male Female FOR CAMPS.COM .CSA Address ______________________________________________________________________________________ TI-CAMP WEBSITEWWW City, State, Zip ________________________________________________________________________________ MUL ECK Phone# (1) ________________________________ Phone# (2) _______________________________________ CH Age at Camp ____________ Birth Date _______________________ E-mail: _______________________________________________________________________________________ Save $... register on-line at www.csacamps.com Please check the camp you would like to attend. 2017 SUMMER CAMP SERIES 6/5 - 6/9 Dynamic Speed and Agility - in conjunction with Architech Sports June 5th - June 9th June 12th - June 16th 5:30 pm - 7:30 pm $190 mail-in application 5:30pm - 7:30pm 9:00am - 12:00pm 6/12 - 6/16 Youth Elite Camp Dynamic Speed and Agility Youth Elite Camp Camp In Conjunction Camp Director: Raymond Fraser 9:00 am - 12:00 pm $190 mail-in application with Architech Sports OrthoCarolina Sportsplex 6/12 - 6/16 Becoming a Better Defender/Midfielder Camp Performance Rising U8-U13 Camp Director: Luke Williams (Boys & Girls) 9:00 am - 12:00 pm $190 mail-in application OrthoCarolina Sportsplex 6/19 - 6/23 Ball Mastery Camp I Rising U8-U18 (Boys & Girls) 5:00 pm - 8:00 pm $190 mail-in application 6/26 - 6/30 BMW Sports Elite Camp June 12th - June 16th June 19th - June 22nd June 19th – June 23rd 9:00 am - 12:00 pm $190 mail-in application 5:00pm - 8:00pm 9:00am - 11:30am 5:00pm – 8:00pm Becoming A Better Ball Mastery Camp I 6/26 - 6/30 Goalkeeping and Striker Camp Defender & Midfielder Recreation Elite Camp Camp Camp Director: Jim Finnerty Camp Director: Mark Thornton 5:00 pm - 8:00 pm $190 mail-in application OrthoCarolina Sportsplex Camp Directors: Dan Dudley & OrthoCarolina Sportsplex Rising U5-U13 Rising U8-U18 CSA Matthews Program Camp Ben Cook OrthoCarolina Sportsplex (Boys & Girls) (Boys & Girls) 7/10 - 7/14 Ball Mastery Camp II Rising U8-U18 5:00 pm - 8:00 pm $190 mail-in application (Boys & Girls) CSA North Program Camps June 26th – June 30th June 26th – June 30th July 10th - July 14th 6/12 - 6/16 Ball Mastery Camp 6/19 - 6/23 Goalkeeping and Striker Camp 9:00am - 12:00pm 5:00pm – 8:00pm 5:00pm - 8:00pm 9:00 am - 12:00 pm $190 mail-in application 5:00 pm - 8:00 pm $190 mail-in application BMW Sports Elite Goalkeeping and Striker Ball Mastery Camp II Camp Camp Director: Andy Guevara Recreation Program Camps Camp Camp Director: Brad Wylde Camp Directors: Mark Thornton & & Rod Jackson 6/19 - 6/22 Recreation Elite Camp 6/19 - 6/22 Recreation Elite Camp - CSA North OrthoCarolina Sportsplex Philip Poole Davie Park Rising U8-U18 9:00 am - 11:30 am $125 mail-in application 9:00 am - 11:30 am $125 mail-in application Rising U6-U18 OrthoCarolina Sportsplex (Boys & Girls) Rising U8-U18 (Boys & Girls) PARENT CONSENT FORM (Boys & Girls) The undersigned hereby certifies to be the parent or legal guardian of _________________, and certifies that CSA North CSA North CSA North my child is physically fit, mentally capable, and medically qualified to participate in the Charlotte Soccer Academy Ball Mastery Camp Recreation Elite Camp Goalkeeping and 2017 Soccer Camp activities. _____________________, the above child’s physician, concurs that my child is June 12th - June 16th June 19th - June 22nd Striker Camp 9:00am - 12:00pm 9:00am –11:30am fully capable of safely participating in these activities. I understand that soccer is an active physical sport and that June 19th – June 23rd Camp Director: Matt Denton Camp Director: Meanu Kayea injuries can occur. I understand that every effort will be made to contact me in case of an emergency concerning Red Ventures Complex Red Ventures Complex 5:00pm - 8:00pm my child. However, if I cannot be reached and/or if time is of the essence, I hereby give permission for the camp Rising U8-U18 Rising U5-U13 Camp Director: Matt Denton staff to seek appropriate medical attention for my child, for medical attention to be given to and received by my (Boys & Girls) (Boys & Girls) Red Ventures Complex At Rising U8-U18 child in the event of accident, illness, or injury during the period of the camp, should it be deemed necessary by (Boys & Girls) camp personnel. I will be responsible for any and all cost of medical attention and treatment. I, the undersigned, for myself and my heirs, executors and administrators, waive, release, and forever discharge the Charlotte Soccer Academy Summer Camp Series 2016 and it’s employees from all rights and claims for damages, injury, or loss to Online person or property which may be sustained or incurred during participation in soccer camp activities. I confirm the following about my child. (If “yes”, please give details on a separate sheet.) PLEASE CIRCLE .csacamps.com Medical conditions: YES NO Allergies: YES NO Register Birth deformities: YES NO Past Illnesses: YES NO www E Fractures or other disabilities: YES NO Contact Lenses: YES NO Camps Pre-existing injury currently under treatment: YES NO Suite Road, Date of last tetanus immunization ___________________________ Academy Child’s health insurance company ________________________________________________________ 28105 Save money and time by securing your place NC Newell Policy #_______________________________ Name of policy holder____________________________ Soccer early and registering online Sam www.csacamps.com ________________________________ Date: ________________________ 901 Matthews, Signature of parent or guardian Charlotte CAMP DIRECTORCAMP DIRECTOR KEY STAFF MEMBERS Brad Wylde Dan Dudley • Coached SCSA's first USYS Regional Championship teams in 2008 and 2009 followed by back to back • 4-year professional player with Carolina Dynamo appearances in the USYS National Championships • Former college Assistant Coach at Catawba College and High Point University Additional Staff Members will come from Charlotte Soccer Academy's Elite Full Time Directors of • An Associate National Staff instructor under the NSCAA teaching State, Regional and Advanced • MSS Master in Sport Science Coaching. Regional courses throughout Southeast • NSCAA qualified and USSF A license Richard Butler - Youth Academy Director • Former college Assistant Coach at Catawba College Jim Finnerty Sean Carlisle - U12 - U13 Girls Director • NSCAA All American at Catawba College and a 4-year professional player with the Charlotte Eagles, • NSCAA All American at Fredonia University Greg Munn - CSA North Director • 3-year professional player with Carolina Dynamo SC Shamrocks and Carolina Dynamo Nathan Wade - U9 - U11 Girls Director • Fully qualified under the NSCAA with multiple licenses through the English FA • Former Director of Coaching for Carolina Soccer Club • Fully qualified with NSCAA, USSF B license • UEFA A license Patrick Daka - Technical Director Tyler Andrus - CSA Matthews Director Ben Cook Raymond Fraser • Regional Director – Challenger Sports Soccer Camps Stephano Williams - CSA Charlotte Director • Former youth player for Rangers in the Scottish Premier League • BSc Sports and Exercise Health Science • Semi-pro player in the U.K • Worked with Scottish FA coaching several youth professional teams; More information on these staff members can be found at • NSCAA Premier Diploma holding numerous licenses with Scottish FA www.CharlotteSoccerAcademy.com • Degree in Sports Coaching and Youth Development at the Scottish School of Sport, Exercise and Philip Poole Outdoor Studies FREQUENTLY ASKED QUESTIONS? • Former professional player with Hull City and Newcastle United in native England • NSCAA Advanced National Diploma, NSCAA Director of Coaching License, USSF C License Who can attend? • Former Assistant Coach with Charlotte Independence Andy Guevara • Assistant Coach and scout for US Women’s National Team Programs Ages start at 5 years old and go to 16 years old. We welcome all ages but some camps are age specific. Check each camp for age restrictions. All camps are • Former MUFC Director open to all players but some camps are very technical and may not be suited for all skill levels. • USSF A License • CSA Matthews Boys Director How do I register? • WISA Collegiate Showcase Camp Coach Wingate University Registration form, parents consent form and payment must be submitted to secure a place in the camp. Spaces are limited and camps will fill up quickly. For Patrick Daka • National Youth License • NSCAA National Diploma • USSF D License teams of 12 or more players, please send applications and team deposit together. To save time and money register online through www.csacamps.com • Former professional soccer player in native Zimbabwe How much does it cost? • Former player and Assistant Coach for USL-Pro League Charlotte Eagles Rod Jackson TAKE ADVANTAGE OF EARLY BIRD DISCOUNT! Register and pay online by April 15th and only pay $135 per competitive camp. No discount on Recreation • Collegiate player at Averett University • NSCAA Advanced Regional Diploma Level Camps. Price include adidas shirt and soccer ball. After April 15th, price is $175 per camp. • Former Director of Coaching for Mecklenburg Union Futbol Club Each competitive camp costs $175 if registration is completed ONLINE, $190 if mailed in application. • USSF B license • USSF E License Recreation camp costs