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TERRY FOLEY ACADEMY SUMMER SOCCER CAMPS

The 2010 Terry Foley Academy Summer Soccer Camps teach an understanding of soccer skills and tactics in a relaxed learning environment. Daily schedule will consist of technical training, small sided games and FUN

Where: Poplar Tree Park - Chantilly, VA
When: July 19 – July 23, 2010 Time: 8:30am - 12:30pm
Or August 23 – August 27, 2010 Time: 8:30 -12:30 pm
Cost: $ 175.00 session Ages: 7 yrs – 18 yrs.

What to Bring:
soccer ball, shin guards, soccer cleats,
water bottle and lunch w/ drink

Directions to Poplar Tree: 4718 Stringfellow Rd, Chantilly
From 66- Take Exit 55 onto Fairfax County Parkway. Head North towards Reston/Herndon. Turn Left onto Fair Lakes Pkwy. Turn Right onto Stringfellow Rd. Turn Left onto Poplar Tree Park. 

Registration Deadline: July 1, 2010. Mail completed registration form, medical form and check payable to: The Terry Foley Academy
FC Virginia
11325 Random Hills Road, Suite 360
Fairfax, VA 22030
Questions: Please contact Lynne McMillan: lsmcmillan@cox.net

MEDICAL RELEASE FORM

TERRY FOLEY ACADEMY
CAMP DATES 2010

July 19 – July 23, 2010
August 23 –  27, 2010
Boys and Girls Ages 7 - 18

REGISTRATION and Medical Information
All REQUESTED INFORMATION MUST BE PROVIDED AND SIGNED.

Camper Name__________________________________________________

Address: _______________________________________________________

City__________________________________________________________

Age______________ Date of Birth ___________________

Phone Contact __________________________________________________

COST: $175.00/Week

HOURS: 8:30 am – 12:30 pm


July Camps Registration Deadline is July 1, 2010. 

Mail completed registration form, medical form and
Check for $175.00 payable to Terry Foley Academy to: 

FC Virginia
11325 Random Hills Road  Suite 360
Fairfax, VA 22030
Questions: Email Lynne McMillan – lsmcmillan@cox.net 

Terry Foley Academy and FCVirginia are not responsible for
any lost or stolen property


Mother’s Name________________________________________________________
Cell Phone_____________________________________________________________
Father’s Name__________________________________________________________
Cell Phone_____________________________________________________________
If Parents/Guardian cannot be reached, call
___________________________________ Phone _____________________________

Family Physician __________________________________
Phone Number____________________________________

Please attach and explain any serious medical conditions and list the names of any medications the camper is presently taking and for what medical conditions.

Allergic to Penicillin Aspirin Other ______________________________________
Insurance Company and Policy Number____________________________________
__________________________has been examined within the last 12 months and no medical reason has been found that he/she cannot participate in this camp. His/Her records show that all immunizations are up to date.

I agree that in case of an accident involving my child while attending camp and with full awareness that soccer is an activity that may involve risk or injury, I release Terry Foley Academy and FCVirginia from any and all liability. In case of an emergency, I give permission to have my child properly transported to a medical facility for care. I understand that Terry Foley Academy and FCVirginia do not provide medical insurance and that I will be responsible for all medical expenses incurred. Terry Foley Academy has established the following procedure for injury or sickness: (1) the camp will call home, (2) call the father's, mother's, or guardian's place of employment, (3) call the emergency numbers and physician, (4) call an ambulance if necessary for transportation to medical facility, (5) attending physician will make judgment on admittance, (6) Terry Foley Academy will continue to call parents, guardian or physician until one is reached. If I cannot be reached and the camp has followed the above procedures, I assume all expense for transportation and medical treatment. I also hereby consent to any treatment, surgery, diagnostic procedure, or the administration of anesthesia which may be carried out based on the medical judgment of the attending physician.


By signing below, I agree to all the terms detailed above

Parent/Guardian Signature Date


______________________________________________