Converse Soccer ID Clinic

Camp will be August 5. Camp will run from 9:00 AM to 4:00 PM

Cost: $110 (includes t-shirt and lunch)

Ages: Highschool Freshman to Highschool Seniors

Schedule:

Check In: 9:00 AM-10:00 AM Check in will be at the Converse Soccer Field (Marsha H. Gibbs Field House, Avant St., Spartanburg, S.C. 29302)

Technical/Small Sided Games: 10:00 AM-12:00 PM

Lunch: 12:00 PM-12:45 PM

Campus Tour: 12:45 PM-2:00 PM

Technical/Full Field Games: 2:00 PM-3:30 PM

Q&A with Coaches: 3:30 PM-4:00 PM

Camper Information:

Email address *

First name *

Last name *

Address 1 *

Address 2

City *

State *

ZIP Code *

Cell Phone Number *

Date of Birth *

Grade *

Parental Information:

First Name *

Last Name *

Parent Email *

Waiver and Emergency Contact

My signature constitutes agreement and authorizes treatment, in case of emergency, and I further submit that my child is physically fit to participate in strenuous athletic activity, and waive Converse College Department of Intercollegiate Athletics, its staff, affiliated entities, their officers, agents and employees from and against any injury, recurrence of any undisclosed pre-existing injury or illness prior to the first day of camp, and all liabilities or causes of action arising out of or in connection with my child’s participation.

Medical Insurance Provider *

Insurance Policy Number *

Emergency Contact Name *

Emergency Contact Number *

Relationship to Camper *

Does your family have medical coverage that includes the applicant? *

Yes No

Are your child's immunizations up to date? *

Yes No

Please list all allergies to food or medications:

Please list all medications currently taking:

I am aware the cost of this camp: *

$110

T-Shirt Size

Small Medium Large X-Large Other

E-Signature: *

Please make all checks payable to: Converse Soccer

Mail checks to:

Rick Parlow-Athletics

580 E. Main Street

Spartanburg, SC 29302

IF you would like to pay by Credit/Debit Card please contact Rick Parlow (864-577-2062).

* required field

Camps & Clinics

Converse Soccer ID Clinic