City 6 Girls Soccer Clinic for Officer John Pawlowski

City 6 Soccer Girl’s Clinic

Drexel, La Salle, Penn, Saint Joes, Temple and Villanova Women’s Soccer Teams

All Proceeds go to:

John Pawlowski Family Memorial Trust Fund

(John’s wife Kimmy Pawlowski played for SJU)

When: April 4th, 2009 1-2:30pm, 12:30pm Registration

Where: Finnesey Field, Saint Joseph’s University

Who: Ages 6-17/ All levels (You are grouped according to age

and ability.)

Why:

v Refresh your skills or learn new skills to enhance your ability.

v Female Collegiate Players as Role Models.

v Small coach to player ratio about 1:7.

v Keeper training for those interested.

v Help out a good cause.

v FUN!!!!!

Schedule:

11am-12pm Saint Joseph’s VS La Salle

12-1pm Saint Joseph’s VS Temple

12:30-1pm Clinic Registration

1-1:10am Opening Ceremonies

1:10-1:20pm Foot skills and juggling-warm up and stretching

1:20-2pm Stations- Finishing, defending, coervers and 1v1’s, possession, passing and receiving, long balls and receiving air balls.

2-2:20pm Small Sided Games

2:20-2:30pm Closing Ceremonies

Cost: $25.00 Donation

You must bring: Water bottle, shinguards, cleats.

Come Early to Catch Some City 6 Teams in Action 9am-1pm

Any questions please contact Coach Jess Reynolds at 610-660-3367 or email jreynold@sju.edu

Please complete and mail along with the check to:

City 6 Soccer Clinic

Attn: Jess Reynolds

Saint Joseph’s University

5600 City Avenue

Philadelphia, Pennsylvania 19131-1395

Please make all checks payable toJohn Pawlowski Family Memorial Trust Fund

Thanks for your support!

Name:_________________________ Age:_______ Grade:_______

Street:______________________________________________________________

City:___________________________ State:___________ Zip:__________

Phone Number:___________________ Email:___________________

Position:________________

Soccer Experience:_____________________________________________________

_______________________________________________________

Waiver Form

Since all campers will be under the age of 18, this waiver must be signed by the child’s parent or guardian.

Statement

I understand City 6 Soccer, its staff and employees, and the City 6 Soccer clinic staff are not responsible for any accident or injury occurring to(child)____________________while attending camp

____________________

Parent/Guardian Signature

Please list any pertinent medical information of which our staff should have knowledge.

Authorization to consent to medical treatment for a minor child

I, (parent/guardian)____________________, state that I am the natural parent and/or have legal custody of(child’s name)____________________.

I authorize ____________________ head coach and clinic director, to consent to any examination, anesthetic, xray, medical or surgical diagnosis or treatment, and/or hospital care to be rendered to this minor under the general conditions of special supervision and on the advice of any physician or surgeon licensed to practice when efforts to contact me are unsuccessful. This consent form is granted for the period of______________________.

Parent/ Guardian Name:_____________________________________

Parent/ Guardian Signature:__________________________________

Date:________________ Emergency Phone Number:___________________________

Medical Insurance Carrier_________________________________________________

Insurance ID #_____________________ Carrier Phone #________________________