Fall ID Clinic: September 12-13, 2015 at UNCW
And see 5 top level NCAA Division I games!
Description
We are excited to offer our Identification and Skills clinic again for 2015. This small ID clinic will be led by UNCW coaches
and players. The ID & Skills clinic is a great way for you and our coaching staff to evaluate and elevate your skill level.
You will be challenged both mentally and physically in this competitive environment. In addition, these programs are a
great way to prepare for your high school and club seasons. There will be Goalkeeper specific training sessions running at
the same time as the field player sessions. * Lunch and accommodations for the clinic will be on your own.
Instruction will include






Technical Work
Positional Play
Attacking
Defending
Team Tactics
GK Specific training sessions
Our Fall ID clinic is designed for high school age players who are serious about playing soccer in College. Our main focus
for the 2 day sessions is to evaluate and identify college level players. While soccer showcases and tournaments are one
way to be evaluated, attending our Fall ID Clinic on the campus of UNCW is another great way to be seen.
We are hosting a tournament over the weekend. The games are not a required part of the ID Clinic, but are included for
your convenience. Tickets are $5 per session of games and can be paid at the front gate.
Seahawk Soccer Fall 2015 ID Clinic
(Tentative Schedule)
FRIDAY September 11, 2015
5:00 pm
7:30pm
St. John’s University vs Campbell University
UNCW vs. University of Richmond
SATURDAY September 12, 2015
8:00 am-8:45am
9:00 – 11:00 am
11:30 – 12:45 pm
1:00 – 1:45 pm
2:00 – 4:00 pm
7pm
Camp registration (UNCW Soccer Office-Almkuist-Nixon Building)
Training Session 1/Evaluation Games
Lunch / Rest
College Team Training (You can observe)
Training Session 2/ Evaluation Games
UNCW Men’s Soccer vs South Carolina
SUNDAY September 13, 2015
8:30 – 10:00am
Noon
2:30pm
Evaluation Games
University of Richmond vs. St. John’s
UNCW vs. Campbell University
Registration Form
Camp Sessions:
September 12-13, 2015
Ages:
13 - H.S. Senior; Gender: Female
$170 for weekend
*This camp is restricted only by grade, gender and number of campers
First Name _________________________ Last Name ______________________
Address ___________________________________________________________
City _____________________ State: ________ Zip: ________Date of Birth: _______
Home Phone ________________________ Cell Phone ______________________
Graduation Year ____________________ Club Team_______________________
High School Team______________________
Parents Email _______________________ Camper Email __________________
Position (Circle): Def Mid Fwd GK
T-Shirt Size (Circle) AS AM AL
AXL
Check Session that you will attend:
 September 12-13 ($170)_____

Yes, I would like a UNCW Logo Soccer Ball ($30)___
Complete Registration Form and return along with your $170 payment for camp ($200 with ball). We will email you a confirmation letter and health waiver form upon receipt of application. Any refunds made (for
cancellation) will be minus a $60 administration fee.
This camp is neither controlled, owned or supervised by UNCW, but rather is under sole supervision and ownership of PCSA LLC
Paul Cairney Soccer Academy LLC (PCSA, LLC) is open and accessible to individuals with disabilities while balancing the risk of physical injury to the individual and others. Participation in the camp by individuals with disabilities is subject to
proper and ongoing review by PCSA, LLC. In order to assess and evaluate a request for an accommodation, PCSA, LLC must receive notice of the individual‟s desire to participate no later than 60 days prior to the commencement of the
applicable camp. Inquiries may be directed to Paul Cairney at 910-962-3932
Forms can be submitted via:
Email (please send forms as attachments): cairneyp@uncw.edu
FAX: 910-962-3608 Attn: Women’s Soccer
Mail: PCSA Fall ID Clinic, UNCW PO Box 20019
Wilmington, NC 28407. Checks made payable to: Paul Cairney
Camper
Birth Date
(Please print full legal name)
Sport
Women’s Soccer
Session Dates (Please check box)
□ Fall ID Clinic, Sep 12-13th, 2015
Release and Medical Authorization
The release and treatment authorization must be signed by a parent or guardian if student is under 18 years old. Students who are 18 years old or will become 18 years
old before the end of the program must also sign. In order for students to participate in camp activities we must have this form. Otherwise parent or guardian must be
contacted prior to participation.
Parent’s/Guardian’s Authorization
This is to certify that
has been examined by a physician within the past year, and that she was found to be
physically able to participate in vigorous physical activity and competitive athletic sports.
Date of last tetanus immunization
Allergies
Drug Sensitivities
Other Medical Problems/Current Medications
What accommodations should be made to insure proper administration and storing of the medication?
Is an identification band or card carried to alert others to the allergy(ies), medical conditions or medication use? Y
N
Signed X
Parent/Guardian
Release of Liability and Medical and Surgical Authorization
In consideration of being permitted to participate in the Paul Cairney Soccer Academy at UNCW, I hereby assume the risks of personal injury that may result from
program activities. I am knowledgeable about the sport, have previously participated in the sport, and am aware of the potential for injury while participating. As a
participant and/or as a parent or guardian, I do hereby release Paul Cairney Soccer Academy LLC, the North Carolina State Board of Regents, The University of North
Carolina at Wilmington, the Sports Camps and their officers, employees and agents, from all liability for personal injury or property damage which result from causes
beyond the control of, and without the fault or negligence of it’s employees, agents or officers.
As a parent or guardian of the above named child, I do hereby release the Paul Cairney Soccer Academy LLC, the North Carolina State Board of Regents, the
University of North Carolina at Wilmington, and any and all volunteers, employees, officers, and agents, of the above named entities, from any and all liability for
personal injury which may occur to my child during the visit to the beach and/or traveling to and from the UNC Wilmington campus and the beach. (sr camp only)
I hereby authorize and give my consent to the health care providers to perform upon or administer to my above named child any reasonable, necessary surgical or
medical treatment. I also give permission to administer whatever anesthetic may be necessary or advisable during the medical or surgical procedures. This
authorization is intended to cover emergency treatment, immunizations, injections, and minor operations and procedures. In the case of psychiatric and/or
psychological emergencies involving psychological treatment, parental authorization for treatment beyond that responsive to the emergency will be requested.
This permission is good only while the student is attending the Paul Cairney Soccer Academy at the University of North Carolina at Wilmington and only until the
student has attained his/her eighteenth birthday.
X
Parent’s/Guardian’s Signature
Date
X
Student’s Signature
Date
Name
Parent/Guardian Print or Type
Address
City
State
Insurance Company
Zip
Insurance Co. Address
Home Phone
Work Phone
Policy No.
Date
Policy Holder