Common Questions about Camp

1. Age & Ability: Players of all size and soccer experience attend camp. The counselors will divide the campers based on age and then on ability. Our goal is to make sure every camper is challenged yet still comfortable.

2. Facilities: Camp is held on the St. Joseph High School Madison campus.

3. What to bring: Each camper should bring a ball, shin guards, and a filled water bottle with them. We will supply extra water for refills. Campers should also bring or wear tennis shoes, a mid morning snack, and don’t forget the sun-screen!

4. Campers can register on-site for $135.

Have

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Co

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Sh

an

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urn

s

Em

ail

:

Sh

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2916

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.co

m

Ph

on

e:

601-

405-0

440

St.

Jo

sep

h C

ath

oli

c S

ch

oo

l 308 N

ew

Man

nsd

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Rd

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MS

3911

0

SOCCER CAMP

ST. JOSEPH CATHOLIC SCHOOL

SOCCER CAMP

May 30th - June 2nd 8:00am - 12:00pm Ages 4 - 12

1:00pm - 4:00pm Ages 13 - 15

EARLY REGISTRATION

ONLY $115

AFTER ARIL 18TH

$135

Reserve you spot today!

Dwyane Demmin

Camp Director

St. Joseph Men’s soccer coach; 7x State Champion 2015 St. Joseph Women’s coach, 2015 State Champion Former member of Belhaven Men’s soccer team 2x Mississippi High School Coach of the Year

2010 National High School Coach of the Year

Dwyane Demmin

Please make check payable to: St Joseph Catholic School

Mail your payment, insurance release form and the registration form to:

St. Joseph Catholic School Attn: Dwyane Demmin

308 New Mannsdale Rd. Madison, Mississippi 39110

Free snow cone for each

camper

Soccer Camp

His footbag Neon Light show to be

performed in the gym is going to be AMAZING!!

Highlights of the Week

Honza Weber will perform some of his amazing footbag (hacky sack) tricks. Some of his accomplishments:

7X World Champion 7x Czech Champion 5x European Champion

Singing/dance competition

Coaches skills competition — Each day coaches will compete against each other to win prizes for their campers.

Campers skills competition

Futsal tournament

Small side games

Soccer tennis and much more

HONZA WEBER PROFESSIONAL FRESTYLER

FOOTBAG (HACKY SACK)

Honza Weber is from the Czech Republic.

He is a professional freestyler in footbag

(hacky sack) and futbal. He will be performing

at the St. Joseph high school soccer camp.

Check out some of his videos on

YOUTUBE. Reserve your spot today.

May 30th – June 2nd

—— 8:00am – Noon

Ages 4-12 Boys & Girls

—— 1:00pm - 4:00pm

Ages 13-15 Boys & Girls

Reserved your spot today!

Camper _______________________________

Parent ________________________________

Address _______________________________

City _________________ Zip ____________

Phone ________________________________

Email _________________________________

Age _______ Grade _______ Boy Girl

School ________________________________

Shirt Size (please check only one)

__ Youth Small __ Youth Medium __ Youth Large

__ Adult Small __ Adult Medium __ Adult Large

Contact in case of emergency:

Name ____________________________________ Phone ___________________________________

REGISTRATION

FORM

Choose Camp

SU

MM

ER

CA

MP

In

form

ed C

on

sent F

orm

Nam

e of Sport

I hereb

y g

ive m

y p

ermissio

n fo

r _________________________________ to

particip

ate in

the S

t. Josep

h’s _

__________________________ S

um

mer C

amp. F

urth

er, I auth

orize th

e

school to

pro

vid

e emerg

ency

treatmen

t of an

inju

ry to

, or illn

ess of m

y ch

ild, if q

ualified

med

ical perso

nn

el consid

er treatmen

t necessary

. The au

tho

rization is g

ranted

only

if I

cannot b

e reached

and a reaso

nab

le effort b

as been

mad

e to d

o so

.

Date _

______________

____ P

arent o

r Guard

ian _

_______________________________

Address _

____________

______________________ P

hone _

______________________

Fam

ily P

hysician

_____

______________________ P

hone _

_____________________

_

Pre-ex

isting m

edical co

nditio

ns (e.g

. allergies o

r chro

nic illn

esses) ______

____________

________________________________________________________________________

A

lternate co

ntact in

case of em

ergen

cy:

NA

ME

_______________________________________ P

HO

NE

______________________

RE

LA

TIO

NS

HIP

TO

ST

UD

EN

T________________________________________________

Med

ical Insu

rance C

arrier __________________________________________________

Policy

Carrier _

_______

____________________________________________________

Policy

Num

ber _

_____

____________________________________________________

_

My ch

ild an

d I are aw

are that p

articipatio

n in

_____________________ is a p

oten

tially

hazard

ous activ

ity. I assu

me risk

s associated

with

particip

ation in

this sp

ort, in

cludin

g, b

ut

not lim

ited to

falls, contact w

ith o

ther p

articipates, o

r oth

er reasonab

le risk co

nditio

ns

associated

with

the sp

ort. A

ll such

risks to

my ch

ild are k

now

n an

d u

ndersto

od b

y m

e.

I und

erstand th

is info

rmed

Consen

t Form

and ag

ree to its co

nditio

ns o

n b

ehalf o

f my ch

ild.

Particip

ant's S

ignatu

re __

_____________________________ D

ate ______

___________

P

lease return

this fo

rm w

ith y

our d

ow

n p

aym

ent. T

han

k y

ou.

CA

TH

OLIC

DIO

CES

E O

F JA

CK

SO

N

St. Jo

sep

h C

ath

olic S

cho

ol

Certifica

tion

of A

cciden

t Insu

ran

ce

As p

are

nt(s) o

r gu

ard

ian

(s) of (n

am

e o

f child

) ______________________________________, a

particip

an

t in th

e S

t. Jose

ph

Cath

olic S

cho

ol S

um

mer P

rog

ram

s, we h

ere

by ce

rtify th

at o

ur

pre

sen

t insu

ran

ce p

olicy

pro

vid

es co

vera

ge fo

r an

y a

cciden

ts wh

ich m

igh

t occu

r du

ring

the

activ

ity.

We a

re a

ware

of th

e re

qu

irem

en

t of th

e D

ioce

se o

f Jack

son

that a

ll child

ren

mu

st have th

is

covera

ge. H

ow

ever, w

e d

o n

ot ch

oo

se to

use

the o

ffere

d sch

oo

l insu

ran

ce p

rog

ram

beca

use

ou

r ow

n in

sura

nce

will co

ver o

ur ch

ild/ch

ildre

n.

I am

also

aw

are

that th

e sch

oo

l is no

t liab

le fo

r an

y d

ed

uctib

le, o

ut-o

f-po

cket e

xpen

ses, o

r

oth

er u

nin

sure

d a

mo

un

ts paid

by m

e o

r oth

ers fo

r med

ical e

xpen

ses in

curre

d b

y m

y ch

ild.

Pare

nt/G

uard

ian

Sig

natu

re:_________________________________ D

ate

: ________________

My ch

ild, ____________________________________________, a

particip

an

t in th

e S

t. Jose

ph

Cath

olic

Sch

oo

l Su

mm

er P

rog

ram

s, is no

t covere

d b

y h

ealth

or a

cciden

t insu

ran

ce. I a

m a

ware

of

the re

qu

irem

en

t of th

e D

ioce

se o

f Jack

son

that a

ll child

ren

mu

st have th

is covera

ge. I

un

dersta

nd

that b

efo

re m

y ch

ild ca

n a

tten

d a

ny o

f the su

mm

er p

rog

ram

s it will b

e

nece

ssary

for m

e to

pu

rchase

Su

pp

lem

en

tal S

tud

en

t Insu

ran

ce.

Th

e sch

oo

l will m

ake a

vaila

ble

a lo

w co

st Su

pp

lem

en

t Stu

den

t Accid

en

t Insu

ran

ce. P

ricing

deta

ils will b

e a

vaila

ble

prio

r to th

e b

eg

inn

ing

of th

e su

mm

er p

rog

ram

s.

I am

also

aw

are

that th

e sch

oo

l is no

t liab

le fo

r an

y d

ed

uctib

le, o

ut-o

f-po

cket e

xpen

se, o

r

oth

er u

nin

sure

d a

mo

un

t paid

by m

e o

r oth

ers fo

r med

ical e

xpen

ses in

curre

d b

y m

y ch

ild.

Pare

nt/G

uard

ian

Sig

natu

re:______________________________ D

ate

: _________________

If yo

ur ch

ild is n

ot co

vere

d b

y H

ealth

or A

cciden

t Insu

ran

ce p

lease

com

ple

te th

e b

otto

m p

ortio

n o

f