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PARENTAL CONSENT FORM

To provide your child with prompt medical care, we must have a com-pleted consent form on file. _________________________________________________ Camper’s Name Birthday (M/D/Y) _________________________________________________ Insurance Company MUST BE PROVIDED!!! _________________________________________________ Policy # or Group # DO NOT OMIT THIS INFO.

MEDICAL INFORMATION _________________________________________________ Known Allergies _________________________________________________ Medication Presently Taking _________________________________________________ Date of Last Tetanus Booster

EMERGENCY NUMBERS _________________________________________________ Father-Name Father-Cell _________________________________________________ Mother-Name Mother-Cell _________________________________________________ Name and phone number to call if parents cannot be reached I certify that_____________________________has my permission to participate in the Augustana College First Touch Elite Soccer Academy. I further certify that the above player has medical insurance in case of injury or emergency. I hereby grant permission to officials of the Au-gustana College First Touch Elite Soccer Academy to act for me accord-ing to their best judgment in any emergency requiring medical atten-tion. Furthermore, I hereby waive and release Augustana College First Touch Elite Soccer Academy , Scott Mejia, Augustana College, its em-ployees, agents, officers and staff for any accident or injury sustained while at camp. _________________________________________________ Signature

_________________________________________________ Father-Work Mother-Work

ENROLLMENT INFORMATION

ACADEMY FEES The fee for the duration of the academy is $300.00 for residential campers and $200.00 for commuting campers. PAYMENT Complete the application and parental consent forms, and mail them with a check made payable to AC First Touch Elite Soccer Academy. No telephone reservations will be accepted. All payments are due no later than July 10th. REFUNDS AND CANCELLATION POLICY All campers who cancel, regardless of reason, will be refunded all pre-paid fees, except a $100.00 handling fee, provided they cancel 10 days prior to camp. Any cancellations within 7 days of camp will be as-sessed a $200.00 handling fee. No refund will be issued for cancella-tions made within 24 hours of the start of camp for any reason. CHECK IN/CHECK OUT Campers will register between 11:00pm and 12:00pm. An all camp meeting will be held at 12:30pm on the first day of camp. The final session will be completed by 12:00pm on the last day of camp. Check out will be held at 1:00pm on the final day of camp. CAMP BALL All campers are required to have a soccer ball at camp. If you would like to purchase a ball while at camp there will be opportunity to do so, but everyone is highly encouraged to bring one from home! CAMP INSURANCE Augustana College First Touch Elite Soccer Academy provides second-ary accident/medical insurance. TRAINERS A certified trainer will be on site to offer prompt attention to minor injuries and ailments. SUPERVISION All campers will be supervised 24 hours a day by camp staff.

Thank you to Gatorade for providing

rehydration to all academy participants!

ACADEMY PHILOSOPHY ACADEMY STAFF 2015 REGISTRATION FORM FACILITIES

ACADEMY DIRECTOR Coach Scott Mejia has been working with summer soccer camps in the Midwest region for the last 19 years. He has worked with the University of Wisconsin-Madison, UW-Parkside and with several other premier residential and day camps throughout Wis-consin, Illinois and Minnesota.

Augustana College Head Coach

Quad Cities Eagles NPSL Men’s Semi-Professional Team Head Coach

2009 NSCAA Central Region Coach of the Year

2012, 2009, 2006, 2002 College Conference of Illinois and

Wisconsin Coach of the Year

2000 Lake Michigan Conference Coach of the Year

USSF National "A" License

NSCAA Advanced National Diploma

NSCAA Level II GK Diploma

Former USYSA Region II ODP Staff Member

PAST ACADEMY STAFF:

Enzo Fuschino, Head Women’s Coach, UW-Platteville

Jon Mannall, Head Women’s Coach, St. Ambrose University

Nikki McLellan, Head Women’s Coach, Knox College

Keri Hess, Assistant Women’s Coach/GK Trainer, Washington University, St. Louis

Eric Stewart, Former Assistant Coach, Notre Dame University

Laurence Thomson, Assistant Women’s Coach,

Augustana College

Our 2014 staff will include college coaches from across the Mid-west. In addition, current and former players from Augustana College will be used as instructors at camp.

*** GOALKEEPERS will receive specialized instruction during every training session!

PREMIER FACILITIES All academy sessions will take place on the campus of Augustana College, one the premier private educational institutions in the coun-try. Located on 115 picturesque acres near the Mississippi River, Augustana has a proud tradition of athletic excellence as demonstrat-ed by the excellent athletic facilities utilized by the camp. Thorson Lucken Field, completed in the Fall of 2011, is the home field for Augustana Women’s Soccer. This field has quickly come to be recognized as one of the best small college stadiums in the country and will be used as the primary training venue for camp. Quality overnight accommodations are essential to an excellent camp experience. As such, all campers will be housed in our most beautiful and newest, fully air-conditioned residence hall on campus, Swanson Commons. Some of the meals will potentially be served in our award winning dining facility at the heart of campus in the College Center. However, when necessary, food will be catered in to accommodate our training schedule.

Name: __________________________________________ E-Mail: _________________________________________ Address: ________________________________________ City: ___________________ State: ____ Zip:___________ Home Phone: _____________________________________ Cell Phone: _______________________________________ Age: _________ Grad Year: _________________________ Each camper will receive 3 camp shirts: Youth t-shirt size: Adult t-shirt size: Lg □ Xlg □ Sm □ Md □ Lg □ Xlg □ Name of High School: ______________________________ Club Team: ______________________________________ Position(s): ______________________________________ Roommate Preference: _____________________________

CAMP FEES AND PAYMENT INFORMATION

Overnight Camper - $300.00 □ Commuting Camper - $200.00 □ Camp tuition is due no later than July 10th.

Make checks payable to: AC First Touch Elite Soccer Academy

Please send payments to:

Scott Mejia Augustana College Women’s Soccer

639-38th Street Rock Island, Illinois 61201

Application will not be processed without completed consent form on

reverse.

The Augustana College First Touch Elite Soccer Academy is designed for advanced soccer players looking to improve their technical and tactical abilities. All players will receive individual attention in a fun, yet challenging learning environment. AC First Touch Elite Soccer Academy will focus on all the major aspects of the game necessary to improve and reach the next level of development. Technical training (skills) and tactical situations will be addressed and taught according to guidelines set forth by the United States Soccer Federation. Individual tactics and small group tactics will also be taught in intense training sessions that culminate in small-sided games every session. This structure will ensure that all participants are involved in the action, thus maximizing contact with the ball and increasing the amount of "problem-solving" each player must engage in. This approach has yielded tremendous results globally and is truly the key in developing creative, exciting and sophisticated soccer players. Every evening campers will take part in scrimmages, which will allow the players opportunity to use their training in full sided 11 v 11 matches. The coaching staff will evaluate the players’ transfer of knowledge gained from the training sessions to the larger game, while also guiding the players in their discovery of the beautiful game! All sessions will be directed by highly qualified college coaches, and current Augustana College women’s soccer team members will be used to facilitate the learning process. All coaches will be selected for their ability to work with highly motivated youth players, their ability to teach the game of soccer, and their ability to be a positive role model for all participants of Augustana College First Touch Elite Soccer Academy. Our goal is simple: to provide all campers an opportunity to improve their game and reach their goals. Whether those goals are to earn a spot on the varsity high school team, or to earn a D1 scholarship, our staff is committed to offering the knowledge and skill necessary to be successful.

If you have additional questions, or require more

Information about our curriculum please call:

AUGUSTANA COLLEGE FIRST TOUCH ELITE SOCCER ACADEMY

309-794-7398