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INDIANA WOMEN'S SOCCER CAMPS

Session I - Dec. 15, 2013
Session II - Jan. 12, 2014
Bloomington, Indiana
at Mellencamp Pavilion, Indiana University campus

CAMP COSTS

$160.00

Campers also need to  provide own soccer ball. Ball can also be purchased during on-line registration for an additional $35

CAMP DETAILS

- Open to Girls grades 8-12
- 9 a.m. - 4 p.m.
-  Campers should bring their own lunch
- All campers receive a free t-shirt

 

FOR REGISTRATION INFORMATION:

Phone: 1-812-856-1481

E-Mail: Click Here!
Register On-Line: Now Available!

All IU Camps are open to all and any entrants

2013-14 Winter Elite ID Academy

As of Jan. 9, Winter Elite ID Camp is SOLD OUT. No additional registrations can be accepted.  
Registration Note: Registrations will be accepted until camp is full. All campers who cancel, including for medical reasons, will receive a full refund minus a $100 processing fee. This will be sent only to those requesting such refund in writing at least two weeks prior to the start of camp. NO REFUNDS are given with less than 48 hours notice before the start of camp for any reason.
 
Which session will you be attending?*
 

Camper's Name (Last, First)*
 
Home Address*
 
City*
 
State*
 
Zip*
 
Parent/Guardian Name(s)*
 
Camper's Home Phone #*
 
Mother's Cell Phone #
 
Father's Cell Phone #
 
Parent's E-Mail Address*
 
Age*
 
High School Graduation Year*
 
Birthdate (Month/Day/Year)*
 
Position (pick one)*
 Goalkeeper
 Position Player
 
Camper's School*
 
Name of Club Team (if applicable)
 
Have you ever attended an IU Soccer Camp (if so, how many times and which camp)?
 
T-Shirt Size*
 S
 M
 L
 XL
 XXL
 
How did you hear about Indiana Soccer Camp?*
 Past Camper
 IUHoosiers.com
 Internet Search
 Camp Brochure/Mailer
 Other
 
If other, please explain.
 
Do you want to purchase an adidas soccer ball for an additional $35? (note: Be sure to select to corresponding option at the bottom of the registration form) *
 Yes
 No
 

MEDICAL CONSENT FORM
To enable the Health Center of Indiana University and/or other health facilities in Bloomington to provide prompt care to your daughter, we must have a completed Consent Form on file each year. This way, we can help your child without delay in an emergency.
 
Name of Minor*
 
Insurance Company*
 
Policy Number/Group #*
 
Name of policy holder*
 
Insurance Company Phone #
 
Drug Reactions
 
Present Medication (include dosage)
 
Allergic Reactions
 
If the camper should be restricted from any activity, please note
 
Date of Last Tetanus Toxoid
 
Any Past Illness or other information that would be useful in the event of medical treatment
 
Name and Phone Number to call if parents cannot be reached*
 

* I grant permission to the Directors, Assistants, or other persons responsible for her care to act on my behalf of said minor in granting permission for evaluation and treatment of medical problems. I understand that should a major medical problem arise, an attempt will be made to notify me by telephone. In the event that I cannot be reached, I hereby give consent to such medical treatment as deemed necessary including surgery, x-ray examinations and anesthesia to be rendered to said minor by a licensed physician or nurse.  

* Waiver: In consideration of being allowed to participate in the Indiana Women's Soccer Camps, I, for myself, my heirs, personal representatives or assigns, do hereby release, waive, discharge and covenant not to sue Indiana Women's Soccer Camps LLC and Forward Marketing LLC, their officers, employees and agents for liability from any and all claims including the negligence of the Indiana Women's Soccer Camp, its officers, employees and agents, resulting in personal injury, accidents or illnesses (including death), and property loss arising from, but not limited to, participation in the Indiana Women's Soccer Camps.  

* By my submission of this registration, I represent that I am either 18 years of age or older, or that I am the parent or legal guardian of the registrant (if he/she is under age 18). I represent I have read the terms of the Privacy Policy, that I understand the manner in which the information collected about the registrant may be used, and that I agree to the use of the registrant’s personally identifiable information in the manner described in the Privacy Policy.  

Parent/Guardian Name*
 

PAYMENT OPTIONS
Please select your payment option by indicating a '1' in the quantity field.
We need a registration form and consents completed for each participant.

Note: A charge from Hoosiersportscamps.com will appear on your credit card for your on-line registration. However, if any of the Hoosier Women's Soccer Camps are canceled for any reason, refunds must be collected directly from Indiana Women's Soccer Camps LLC, 1001 E. 17th Street, Bloomington, IN 47408. Phone 812-855-9442.
 
Qty 
 $160.00 Option 1 - Individual Registration - Payment in Full

 $195.00 Option 2 - Individual Registration with soccer ball purchase - Payment in Full