GOALKEEPER CAMP
Director: Jamie Smith
-Current Faust Junior High Girls� Soccer Coach
-Former Wilson College Women�s Head Soccer Coach
-Former Frostburg State University Women�s Soccer
Assistant/Goalkeeper Coach
-Former Semi-Professional Goalkeeper with Northern Virginia Majestics &
Maryland Pride
-Former Campbell University, Div 1, Goalkeeper
-NSCAA National Diploma
-NSCAA Level 1 Goalkeeper License
college players also welcome
Jamie Smith,
1928 Wood Duck Drive West Chambersburg,PA 17202
Return form and $50 fee by July 11,2008 to Jamie Smith:
1928 Wood Duck Drive West,Chambersburg,PA 17202
__________________________________ ___________ ___________________________
Name Age Phone Number
__________________________________________________________________________________
Address
_________________________________________________________________________
Emergency Contact & Phone Number
_______________________________________________________________________
Any medical conditions we should be aware of.
_________________________________________________________ T-Shirt Size YS YM YL E-mail Address (circle one)
A S AM AL AXL
RELEASE WAIVER
I the undersigned waive, and forever discharge the Heart & Desire Goalkeeper Camp and Franklin County Career and Technology Center and it's staff, officers, and employees from any and all liability, claims, demands, and causes of actions arising out of or related to any loss, personal injury, or property damage that may be sustained or occur during participation in camp activities while attending the Heart & Desire Goalkeeper Camp.
_________________________________________________________ __________________
Signature of parent or guardian Date