bascomepsc 2015 application form

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History...The Pro Soccer Clinic, founded by Bascome/Goater Pro Soccer, sponsored by Validus, has had more than 6,000 participants over the past 24 years. Look out for the new Pro Soccer Clinic logo in the year to come and stay connected with us at www.bascomeenterprise.com! Clinic 1 June 29 - July 3 Clinic 2 August 17 - August 21 North Field, National Sports Centre Males and Females | Ages 4 - 16 Kiddy Kickers Group (Coed Clinic) 4 - 5 years 6:00pm - 7:00pm Basic Group (Male and Female Groups) 6 - 10 years 6:00pm - 8:00pm Bridge to Success (Male and Female Groups) 9 - 16 years 6:00pm - 8:00pm Pro Soccer Clinic 2015 Health Details Bascome Pro Soccer Clinic 2015 Your child’s health is important to us, if there are any medical conditions relating to your child please explain below. Does your child have allergies? m Yes (Please explain below) m No Are there any other medical conditions we should be made aware of? m Yes (Please explain below) m No

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BascomePSC 2015 Application Form

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Page 1: BascomePSC 2015 Application Form

History...The Pro Soccer Clinic, founded by Bascome/Goater Pro Soccer, sponsored by Validus, has had more than 6,000 participants over the past 24 years. Look out for the new Pro Soccer Clinic logo in the year to come and stay connected with us at www.bascomeenterprise.com!

Clinic 1 June 29 - July 3 Clinic 2 August 17 - August 21North Field, National Sports CentreMales and Females | Ages 4 - 16

Kiddy Kickers Group (Coed Clinic)

4 - 5 years 6:00pm - 7:00pm

Basic Group (Male and Female Groups)

6 - 10 years 6:00pm - 8:00pm

Bridge to Success (Male and Female Groups)

9 - 16 years 6:00pm - 8:00pm

Pro Soccer Clinic 2015

Health Details Bascome Pro Soccer Clinic 2015Your child’s health is important to us, if there are any medical conditions relating to your child please explain below.

Does your child have allergies?

m Yes (Please explain below) m No

Are there any other medical conditions we should be made aware of?

m Yes (Please explain below) m No

Page 2: BascomePSC 2015 Application Form

Registration Form - Bascome Pro Soccer Clinic 2015 To confirm your child’s registration please submit the completed registration form and fee in the drop box located at Sportseller, in the lower level of the Washington Mall. The deadline to register: Clinic 1 - June 19; Clinic 2 - August 7. You will only be contacted if the clinic reaches its maximum capacity and your application can not be accepted. If you are not contacted your child’s registration is confirmed.

Player’s Name Please print ALL information clearly m Male m Female

Address Please print ALL information clearly Postal Code

Date of Birth day | month | year Age

Parent/Guardian Name Please print ALL information clearly

Telephone (home) (work) (cell)

Email

Payment Methodsm Cash m MasterCard m Visa m Check Make all checks payable to Bascome Enterprise

Credit Card InformationName on Card Cardholder name and signarture MUST match.

Signature of Cardholder

Card Number Expiry Date month | year

Kiddy Kickers Group 4 - 5 years (Coed) 6:00pm - 7:00pm

m Clinic 1 or m Clinic 2 | m Clinic 1 & Clinic 2

m $30.00 (before deadline) m $35.00 (after deadline) | m $50.00 (Clinic 1 & 2) m $55.00 (after deadline - Clinic 1 & 2)

Participating Parent/Guardian Name Please print ALL information clearly

Basic Group 6 - 10 years (Male and Female Groups) 6:00pm - 8:00pm

m Clinic 1 or m Clinic 2 | m Clinic 1 & Clinic 2 | m Male m Femalem $70.00 (before deadline) m $75.00 (after deadline) | m $130.00 (Clinic 1 & 2) | m $135.00 (after deadline - Clinic 1 & 2)

If the player is 9 or 10 years old they have the option to participate in the Basic Group and/or Bridge to Success.

Bridge to Success 9 - 16 years (Coed) 6:00pm - 8:00pm

m Clinic 1 or m Clinic 2 | m Clinic 1 & Clinic 2 | m Male m Femalem $70.00 (before deadline) m $75.00 (after deadline) | m $130.00 (Clinic 1 & 2) | m $135.00 (after deadline - Clinic 1 & 2)

If the player is 9 or 10 years old they have the option to participate in the Basic Group and/or Bridge to Success.

As a parent/guardian of the child registered for the Bascome Pro Soccer Clinic 2015, I certify that the participant(s) are in excellent physical health and capable of participation in the Bascome Pro Soccer Clinic 2015. I hereby agree to waive all costs, damages, losses and expenses of any kind whatsoever resulting from or in connection with the activities in which my child undertakes as a participant of the Bascome Pro Soccer Clinic 2015 and indemnify and hold harmless the coaches, staff, organisers, supervisors and sponsors of the Bascome Pro Soccer Clinic 2015. I grant permission for my child’s picture to be taken or appear in video for promotional materials created and published to promote the Bascome Pro Soccer Clinic and the programme’s partnership with sponsoring organisations.

Parent/Guardian Signature

Date

Does your child have any allergies or physical challenges you feel we should be made aware of? If yes, please explain on reverse side of this registration form. m Yes m No

Pro Soccer Clinic 2015

Page 3: BascomePSC 2015 Application Form

Bascome Pro Soccer Clinic 2015Kiddy Kickers The Kiddy Kickers programme, a starter clinic for players ages 4 & 5 years old introduces them to the FUN-damentals of soccer. A parent or guardian must accompany each player for the entire daily one hour training session. Players will be taught basic soccer skills and fun drills. This is a chance for parents to get actively involved!

Basic Group Open to male and female players ages 6 - 10 years the Basic Group provides players with the opportunity to build on their soccer skills and be taught the importance of positive discipline and becoming team players both on and off the field. Participants will be taught by qualified coaches and experienced players. Male and female players will be in separate groups.

Bridge to Sucess Open to male and female players ages 9 to 16 years, the Bridge to Success programme will give players the tools to become the model player. In addition to providing players with the opportunity to build on their soccer skills, learning positive discipline and becoming team players on and off the field, participants will focus on overall technique, the value of possession, their values as players and participate in blackboard/life skills sessions.

At the end of the week each player will be evaluated to ensure they have learned and understood the importance of the information they received. Players will then be selected to receive a scholarship to the Validus Power of One camp. Areas are Game Awareness, Health and Fitness and Social Conduct.

The CoachesDavid BascomeHometown: BermudaPresident of Bascome Enterprise MISL Professional and Assistant Coach for Baltimore Blast

Mike Williams, Pro Soccer Clinic Clinic DirectorHometown: Washington D.C.Vice President of Bascome EnterpriseFormer Professional Outdoor/Indoor Player, Professional College Scout

Danny KellyHometown: Baltimore, MarylandMISL Professional and Head Coach for Baltimore Blast

John Barry NusumHometown: Bermuda Former Professional and Youth Coach

Jonatas Melo Hometown: Brazil Professional Player for Baltimore Blast

William VanzelaHometown: BrazilProfessional Player Baltimore Blast.Italy’s National Fut Goal Keeper

Kati Jo SpisakHometown: Germantown, MarylandUSA Professional Womans Coach

Danielle MalagariHometown: Germantown, MarylandUSA Professional Womans Coach

Dante Leverock Hometown: BermudaPro Soccer Clinic Assistant, Profesional Player Harrisburg City Islanders

Keishun SmithHometown: Bermuda Youth Coach, Premier Team Coach

Kevin SimpsonHometown: Bermuda Youth Coach

Proudly sponsored by

Page 4: BascomePSC 2015 Application Form

The SpecificsClinic 1 June 29 - July 3 Clinic 2 August 17 - August 21Kiddy Kickers Group | Basic Group | Bridge to SuccessVenues North Field, National Sports Centre, Roberts Avenue, Devonshire DV01

Age Groups 4 - 5 years Kiddy Kickers Group - Coed 6 - 10 years Basic Group Males | 6 - 10 years Basic Group Females 9 - 16 years Bridge to Success Group Males | 9 - 16 years Bridge to Success Group Females

Attire Basic Group/Bridge to Success Soccer boots | Shin Guards | White Socks | White Shorts | White Tshirt Kiddy Kickers Group Youth and adult participants may wear sneakers instead of soccer boots. Adult participants in the Kiddy Kickers Group do not have to wear white attire. All Pro Soccer Clinic participants will receive a Tshirt. Tshirts must be worn for group photos.

Clinic Capacity per week 48 males and females total maximum players for Kiddy Kickers Group 200 males and females maximum players for Basic Group 100 males and females total maximum players for Bridge to Success

Registration | Orientation | Fees Clinic 1 June 29 - July 3 Registration deadline: June 19

Clinic 2 August 17- August 21Registration deadline: August 7

Orientation Saturday, June 27th 4:00pm - 6:00pm North Field, National Sports Centre Clubhouse

Orientation Saturday, August 15th 4:00pm - 6:00pm North Field, National Sports Centre Clubhouse

Fees Kiddy Kickers $30.00 one clinic | $50.00 both clinics $35.00 and $55.00 (after deadline)

Basic Group $70.00 one clinic | $130.00 both clinics $75.00 and $135.00 (after deadline)

Bridge to Success $70.00 one clinic | $130.00 both clinics $75.00 and $135.00 (after deadline)

Fees Kiddy Kickers $30.00 one clinic | $50.00 both clinics $35.00 and $55.00 (after deadline)

Basic Group $70.00 one clinic | $130.00 both clinics $75.00 and $135.00 (after deadline)

Bridge to Success $70.00 one clinic | $130.00 both clinics $75.00 and $135.00 (after deadline)

Mandatory pick up of Tshirt, water bottle, clinic specifics and group assignment.

Registration Options Drop Box located at Sportseller, located in the lower level of the Washington Mall.Complete an application form, with payment (check, cash, Visa or MasterCard) and drop in box. Make all checks payable to: Bascome Enterprise

Registration Confirmation To confirm your child’s registration please submit the completed registration form and fee Monday - Friday, 9:00am to 4:30pm by registration deadline dates listed above. You will only be contacted if the clinic reaches its maximum capacity and your application can not be accepted. If you are not contacted your child’s registration is confirmed.

Pro Soccer ContactJakisha Douglas, Pro Soccer Clinic Administrator Tel +1 441 747 5589 | Email [email protected]

Website www.bascomeenterprise.com

Training Schedule Kiddy Kickers GroupClinic 1 June 29 - July 3 Clinic 2 August 17- August 21

Monday - Thursday | 6:00pm - 7:00pm | Coed Soccer Clinic

Friday | 6:00pm - 7:00pm6:00pm - 7:00pm | Coed Soccer Clinic7:00pm | PresentationPhotos will be taken. Pro Soccer Clinic Tshirts to be worn by all participants.

Basic GroupClinic 1 June 29 - July 3 Clinic 2 August 17- August 21

Monday - Thursday | 6:00pm - 8:00pm | Soccer Clinic (Male and Female groups)

Wednesday | 7:30pm - 8:00pm | Soccer Tennis Tournament (Parent participation)

Friday | 6:00pm - 7:30pm6:00pm - 7:30pm | Skills Competition7:30pm | PresentationPhotos will be taken. Pro Soccer Clinic Tshirts to be worn by all participants.

Bridge to SuccessClinic 1 June 29 - July 3 Clinic 2 August 17- August 21

Monday - Thursday | 6:00pm - 8:00pm | Soccer Clinic (Male and Female groups)• Soccer Clinic (functional ball work and fitness training)• Blackboard work/life skills sessions (health, social talk and game awareness teaching)• Training on field (value of possession and game awareness)

Friday6:00pm - 7:30pm | Basic Skills Competition7:30pm | PresentationPhotos will be taken. Pro Soccer Clinic Tshirts to be worn by all participants.