�

�

�

�

�

� �

�

�

�

�

�

� �

�

�

�

�

�

�

�

�

�

�

�

������������ �������

Date & Time: July 9th – 12th 2012 6:00 pm - 8:30 pm

Location:

Ronald Reagan High School Soccer Fields 3750 Transou Road

Pfafftown, NC 27040

�

�

�Boys & Girls

K - Rising 9th Graders

Contact: Camp Director Paul Hicks

(336) 655-7903 coachhicks1@gmail.com

www.1sttouchsoccercamp.com

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Send Us Your Information

Camper_____________________________________

�

Age ______

�

Address_____________________________________

___________________________________________

Phone Number_______________________________

Email_______________________________________

T-Shirt Size

YM YL AS AM AL

Cost Information:

$100 per camper

Make checks payable to: First Touch Soccer Camp

Mail check, registration and medical waiver to:

First Touch Soccer Camp

Attn: Paul Hicks

1713 Oliver’s Crossing Circle

Winston Salem, NC 27127

�������

����� �������

��������� �����

������

������

��

����������� ������������

��������

������ �������

�

�

�

�

�

�

�

�

�

�

�

�

�

�

Camp Staff

Camp Director: First Touch Soccer Camp is directed by Ronald Reagan Men’s Soccer head coach Paul Hicks. He has been selected All-Conference and All-Region Coach of the Year. Coach Hicks led the Raiders to their first Winston Salem Soccer Spectacular championship in 2010. He has worked in youth soccer for over 10 years with local clubs and soccer programs.

Assistant Camp Directors: ������������������������������ ������������� ����� ������������������� ���������������� ����������������������������� ������ � ��������������� ���������!�! ���"���� !��� ������#��������$�%�&����������!��� �� ����� �"���� !������� ����!������� �����!������ ������������������"���������� �������� �'�� ��������� ������� �( ���%��&"�)�� ����� ��������������� ����������� ��� ������� �����! �������������� ������������ ������������ �"

What to Bring: T-shirt Cleats

Shorts Water Bottle

Shin guards Soccer ball

Soccer Socks Sunscreen

Please label each piece of equipment with your

Camp Objective

This camp will focus on teaching the fundamentals of

soccer. Teaching proper technique and love for the

game, is the mindset of our Camp Staff. Come ready

to learn and most of all have FUN!

Testimonial:

“This is one camp that both my kids request to go to

each summer. It is very well organized and the

coaches are top-notch. No matter what your child's

skill level is, they will walk away with new and

improved skills from this camp.”

Parent- Gina Shore

�

�

First Touch Soccer Camp Medical Waiver

I____________________________________, am the parent/legal guardian of ____________________________________I fully understand and appreciate the potential dangers, hazards and/or risks, directly and/or indirectly inherent in participating in this activity, which could also include loss of life, serious loss of limb, or loss of property.

In consideration for being allowed to participate in this activity, I agree to hold harmless the supervisor(s) and coordinator(s) of this activity, First Touch Soccer Camp & Ronald Reagan High School, its agents, officers, employees and student volunteers harmless for any and all direct, indirect, special or consequential damages, or costs, legal and otherwise, which I may incur as a result of my participation in this activity, even if due to the reasonable negligence of any person serving in the above-identified capacities.

I have read the terms of this agreement/Release and I understand and voluntarily agree to the terms and conditions. This agreement/release shall be binding upon the heirs, administrators, executors and the assigns of the undersigned.

Participant Name______________________________________

Signature of Parent/Guardian____________________________

In Case of Emergency

Your Insurance Company_______________________________

Policy Number________________________________________

Name of Policy Holder_________________________________�

Emergency contact / Phone #____________________________�

Hospital Preference_________________________

Are there allergies or medical conditions that the camp

staff should be aware of?

Yes____ No_____

If yes please describe: ____________________________

*�*�*�*�*�*�*�*�*�*�*�*�*�*�*�*�*�*�*�*�*�*�*�*�*�*�*�*�*�*�*�*�*�*�*�*�*�*�*�*�*�*�*�*�*�*�*�*�*�*�*�*�*�*�*�*�*�*�*�*�*�*�*�*�*�*�*�*�*�*�*�*�*��