2022 Manchester, NH Clemson Camp Registration

REGISTRATION CURRENTLY CLOSED

Your name (as shown on your passport)

Your date of birth (mm/dd/yyyy)

Your phone number

Your email

Emergency contact name

Emergency contact phone number

% Service connected VA disability (for grant funding purposes)

Disability type for soccer identification impairment working with veterans
CP/TBI/Stroke VisualVisual ImpairmentPTSDProfessional working with veterans (Rec Therapist, PT, OT, advocate etc)Other (Explain in comments)

Military branch/organization you are/were involved with?

Shirt size (Adult Unisex)
XSSMLXLXXLOther (explain in comments)

Reason you would like to be included in this VA adaptive soccer camp and US Soccer Coaching Certification?

Which of the following represents your current level of soccer knowledge/skills (select all that apply)?
I have no knowledge or previous experience in playing, coaching, or refereeing soccer.I have basic knowledge of soccer (i.e., rules of the game, field positions, equipment requirements)I am knowledgeable/skilled in playing soccerI am knowledgeable/skilled in coaching soccer (i.e., planning + leading soccer practices related to athlete’s physical fitness, strength training, and soccer-specific drills)I am knowledgeable/skills in refereeing soccer (i.e., i.e., rules of the game, personal fouls, penalties, etc.)

List any special accommodations that will be needed (eg. large print, food restrictions, pet friendly room, risk triggers, etc)

Will you commute to camp or do you need a hotel room?
I will commute everydayI need a hotel room (no extra fee; determined on a case-by-case basis)Other (explain in comments)

Comments/Ideas/Other explainations (optional)

By Submitting this form, I understand, if selected, I am committed to be in attendance for the full camp period and will complete the necessary coaching certification material provided PRIOR to attending the clinic
No, please do not include me in this program as I am not 100% committedYes, I understand this

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