NJSA 04
USSF Zone 1
Junior Development Academy
*Winter 2012 Indoor Soccer Clinic*
Boys & Girls U6-U10
Born 2002 - 2006
Tab Ramos Sports Center, 17 Blair Road, Aberdeen, NJ 07747
Monday’s, January 9th – March 12th (10 Weeks) 5:00pm – 6:00pm
We are offering a 10 week soccer clinic to advance young players to the next level concentrating on footskills, coordination and technique.
The focus will be to develop players to their fullest potential. Special guest appearances by professional trainers are being planned to work with participants.
Equipment: Size 3 Soccer Ball, Water Bottle. All players must wear shin guards and indoor soccer shoes.
Cost: Register by Nov 25th $235. (After Nov. 25th $285.)
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REGISTRATION FORM
If you are registering for this program please e-mail NJSA04JDP@GMAIL.COM
for information on where to send it.
Child’s Name ____________________________________________________________Age__________ Birthdate____________________
Address_______________________________________________City_______________________________State/Zip__________________
Home Phone ________________________Mobile Phone______________________ Parent’s E-mail ____________________________
Emergency Name & Number________________________________________________________________________________________
Make Check Payable to: TRSP T-SHIRT (YOUTH) SIZE: PLEASE CIRCLE: S, M, L, XL
Medical Release / Liability Waiver
I, we assume all risks incidental to such participation in the sport of soccer, including transportation to and from any such activities. I, we, hereby waive, release, and absolve the organizers, sponsors, TRSP and NJSA 04 staff, and participants from any claim arising out of injury to my son and/or daughter.
Moreover, I, we, do hereby certify and assure that my, our, child/children (registering for his program) is in sufficient health to endure the rigorous activities and drills that are common in participation of soccer, a contact sport.
Furthermore, I, we, do hereby acknowledge, understand, and agree that it is my, our responsibility to inform the appropriate TRSP and NJSA 04 staff official of any health related complications, illness, conditions regarding the applicant and/or prescription medication being taken by the applicant.
____________________________________________________ ____________________________________________________
Name of Participant Name of Parent/Guardian
____________________________________________________ ___________________________________________________
Signature of Parent/Guardian Date
