East Select Soccer would like to extend a personal invitation to participate in our East Side Strikers Program and our Youth Development Program. We would like to have you participate in our camps because of your enthusiasm for the game! This is our 17th year of developing aspiring soccer players. ESS is hosting three outstanding professional coaches this year from Brazil, Germany and England. We will be offering two opportunities to learn from them. East Side Strikers: This program is designed for players between the years of 4 and 8 years of age. We will run a weekly one hour clinic from 6-7pm every Monday from June 9th to June 30th (Total of 4 sessions). This clinic is for players of all ages and will focus on skill development in a fun and entertaining way. All sessions will run at the new Duluth East High School Stadium. Cost: $40 per player, $35 per player for families with multiple players. East Side Striker Shirts included. Youth Development Program: This Monday-Thursday camp will run for players between the ages of 6-12 between July 21st to July 24th. Each session will be an hour and a half with two different options to fit your schedule (10:30-12 or 5:30-7). Your kids will learn from the ESS professional coaches, local coaches and older players. This clinic is for kids of all skill levels and will focus primarily on skill development. All sessions will be held at the new Duluth East High School Stadium. Cost: $50 per kid, $45 per player for families with multiple players. For more information please contact: Steve Polkowski Director of Coaching- East Select Soccer [email protected] 218-464-7009 East Select Soccer Registration Circle for Registrations: East Side Strikers YDP AM Session (10:30-12) YDP PM Session (5:30-7) Player Information: Name: First: _______________________ Last: ___________________________ Address: _____________________________ City: ________________________ State: ________ Zip: _____________ Birthday: ____________ Age: ______ Gender: ____________ School: _______________________ Parents Name: _________________________________ E-Mail: _____________________________________________ Cell Number: _______________________________ T-Shirt Size (East Side Strikers) _________________ *** Medical Information & Consent *** Alternate Emergency Contact: ______________________________________ Cell #: _____________________________ Doctor: __________________________________ Clinic: _______________________ Phone: ______________________ Hospital Preference: ________________________________ Medical Insurance: ________________________________ Dentist: ________________________________ Office: _________________________ Phone: _____________________ Dental Insurance: _____________________________________________ Agreement: I, the parent/guardian of the registrant, a minor, agree that I and the registrant will abide by the rules of the United States Youth Soccer Association (USYSA), the Minnesota Youth Soccer Association (MYSA), East Select Soccer (ESS), and its affiliated organizations and sponsors. Recognizing the possibility of physical injury associated with soccer and in consideration for the USYSA, the MYSA accepting the registrant for its soccer programs and activities (the “Programs”). I hereby release, discharge, and/or otherwise indemnify the USYSA, MYSA, ESS and its affiliated organizations and sponsors, their employees and associated personnel, including the owners of fields and facilities utilized for the programs, against any claim by or on behalf of the registrant as a result of the registrant’s participation in the Programs and/or being transported to or from the same, with transportation I hereby authorize. Medical Release: As the parent or legal guardian of a participant in the USYSA/MYSA/ESS programs, I give consent for emergency medical care by a duly licensed Doctor of Medicine or Dentistry. This care may be given under whatever conditions are necessary to preserve the life, limb or well-being of my dependent. Parent/Legal Guardian: (please print) ________________________________________ Date: ______________ Signature: ___________________________________________ Payment Information: Checks made payable to: East Select Soccer PO Box 3272 Duluth, MN 55803