Paul Stumpf UCSB Head Coach PAUL STUMPF SOCCER ACADEMY UNIVERSITY OF CALIFORNIA SANTA BARBARA College ID Camp December 18th & 19th, 2010 Hamid Sedehi Asst. Coach Collegiate Experience Soccer Camps RACHAEL RITCHEY UCSB COACHES RUNNING EVERY SESSION 2 TRAINING SESSIONS A DAY DAILY SPECIALIZED GK TRAINING EXPERIENCE COLLEGE LIFE IN A CAMPUS SETTING NUMEROUS COLLEGE COACHES IN ATTENDANCE A GREAT WAY TO SEE WHAT IT IS LIKE TO TRAIN AT THE DIVISION I LEVEL GENELLE IVES FOR THE SERIOUS PLAYER WHO WANTS TO PLAY COLLEGIATE SOCCER $200 PER PLAYER Great Coach to Player Ratio ~ NCAA Division I, II & NAIA Coaches Nike Gear For All Campers! To Register By Mail, Send Check Payable To: Paul Stumpf Soccer Academy Santa Barbara, CA 93111 Phone: (805) 455-5489 Email: paul.stumpf@athletics.ucsb.edu Open to all Players CAMP REGISTRATION FORM Full Name: CAMP REGISTRATION FEE DOES NOT INLUCDE FOOD OR HOUSING. HOWEVER, WE CAN Address: PROVIDE BOTH. PLEASE CALL FOR DETAILS. Email Address: ALSO, PLEASE CALL IF YOU NEED TRANSPORTATION FROM THE LOCAL AIRPORT OR TRAIN STATION. Phone #: Yr of Grad: T-Shirt Size (circle one): AS AM AL AXL Do you have medical insurance? (circle) Yes No Short Size (women s): S M L XL If Yes, Policy #:
2010 Paul Stumpf Soccer Academy at UCSB REGISTRATION & CONFIRMATION PACKET December 18 & 19, 2010 Thank you for registering for the 2010 Paul Stumpf Soccer Academy at UCSB! We hope that the Paul Stumpf Soccer Academy at UCSB will be an exciting and memorable experience for you. The information in this packet is very important, so, please take a moment and read it carefully. Feel free to call, or email us at anytime with any questions your may have. E-mail is the best way to contact us, and get direct answers to any of your questions. Thanks, Camp Director Paul Stumpf Cell: (805) 455-5489 Fax: (805) 893-5551 Paul.Stumpf@athletics.ucsb.edu Fill out and return pages 3 and 4 of this packet to us as soon as possible, but no later than 1 week prior to the camp. Obviously, if we are going to pick up the campers from the Santa Barbara airport or from the local bus/train stations, or if there is a roommate request, the sooner we know the better. Our mailing address is as follows: Paul Stumpf Soccer Academy (PSSA) Santa Barbara, CA. 93111 What Every Camper & Parent Should Know: CAMP DATE December 18 & 19, 2010 Registration/Check-In: (2 Options) Option #1: Friday Dec. 17 th between 6 & 9 PM in the lobby of Tropicana del Norte Dormitory. 6525 El Colegio Rd. Goleta, CA. 93117. Option #2: Saturday Dec. 18 th between 12 & 1:30 PM at Rob Gym Field, which is where the camp will be held. It is on the campus of UC Santa Barbara on Ocean Rd. next to the Recreation Center. Camp Ends: Camp will end on Sunday, at 4:00 pm, with a checkout time of 5:00 PM Health / Personal Form: You must send this information back to us by the first day of camp. We cannot admit anyone to the camp without this information.
Health & Safety: We will have an athletic trainer at camp the entire time. Drugs, Alcoholic beverages and tobacco products are strictly forbidden and constitute, along with general misconduct, grounds for immediate dismissal from camp without a refund. Early Arrivals / Late departures: Early arrivals and late departures are discouraged. However, if a camper must arrive early or stay late, please contact us, and we will help out in finding you accommodations. Cancellations: If you must cancel, please do so as early as possible so that we can notify those on the waiting list! No refunds will be issued for any reason once the camp session has commenced! Roommates: Campers, who will be staying with us, will stay in suites that will have from 3 to 4 other campers in them. Rooms will be assigned randomly unless you fill out and return the roommate request form. Roommate requests are not guaranteed, but we will do our best to match you with your friends. Lights Out: Lights out will be at 10:30pm every night. This means we need to be quiet so that everyone staying in the dorm facility can get his or her rest. This also means that there may be boys at the dorm facility. If any camper is found in the dorm room/suite of a boy, they will be immediately dismissed from the camp. There, of course, will always be a staff person staying at the dorms at all times. Daily Schedule for this camp: December 18: Training Session #1 2-4 PM on Rob Gym Field Training Session #2 6-8 PM on Rob Gym Field December 19: Training Session #1 9-11 AM on Rob Gym Field Recruiting Discussion 11:30 to 12:30 PM in ICA Bldg. Training Session #2 2-4 PM on Rob Gym Field Checklist of Things to bring to camp: *Soccer Cleats/Turf Shoes *Shin guards *Water Bottle * Spending Money * Sunscreen *Sweats *Training gear/2 days Additional Checklist of things to bring if staying in the dorms: *Bed Linens / Sleeping Bag *Swimsuit *Pillow *Towels
Health & Release Form Camper s Name: Camp Dates: Street Address: Apt. # City: State: Zip: Home Phone: Work Phone: Email: Emergency Contact: Phone: Health and General History: If the camper should be restricted from any activity please note: If the camper will be taking medication during camp, please indicate name of drug and dosage: Please identify any medical condition or medical history that would require special attention: I hereby certify that the named camper is physically able to participate in the Elite Soccer Camp at UCSB and that I know of no restrictions, physical impairments, or any other facts, which in any manner limit his/her participation in such a program: Signed: Date: Health Insurance Information Carrier Name: Policy Number: Policy Holder Name: Policy Holder Date of Birth: I, (parent if under 18yrs), give the permission for the named camper to receive medical or surgical treatment and hospitalization if necessary. I understand that every attempt will be made to contact me, or the emergency contact named above, before taking this action. I hereby waive and release the Staff, Camp Management and any sponsors from any and all liability for any injury or illness incurred while at camp. I UNDERSTAND THAT THERE IS RISK OF INJURY TO THE NAMED CAMPER AS A RESULT OF CAMP ACTIVITIES, AND KNOWINGLY AND VOLUNTARILY ASSUME ALL RISK OF SUCH INJURY. I will be financially responsible for any medical attention needed during camp or resulting from an injury received at camp. My medical insurance shall be the insurance coverage for any medical treatment. Signed: Date:
Please circle those illnesses or conditions, in which the camper has had: German Measles, Measles, Mumps, Asthma, Chicken Pox, Pneumonia, Diabetes, High Blood Pressure. Immunizations Allergies Drug Reactions (show dates) (yes/no) (yes/no) Tetanus Taxoid Hay Fever Sulpha Polio Vaccine Asthma Penicilin Tuberculin Test Eczema Anitbiotics Measles Insect Stings (type) Rubella Other Aspirin Mumps Other Other Physicians Name: Phone: Please Mark which camp week you will be attending December 18 & 19, 2010 Travel Arrangements/Roommate Requests To Camp: From Camp: Arriving By: Train, Bus, Airplane Leaving By: Train, Bus, Airplane Coming From: Going To: Airline: Airline: Flight #: Flight #: Arrival Time: Departure Time: We can only provide transportation from the Santa Barbara Airport, Goleta Train Station, and Goleta Bus Station. Campers Name: Roommate Request: Position Preferred: Club Team: Return This Sheet To: Paul Stumpf Soccer Academy (PSSA) Santa Barbara, CA. 93111 Or fax to 805-893-5551 Please attach a photo (head shot), so that we can begin to match your face with your name!!!