WOMEN S SOCCER ELITE ID CAMP Sunday, March 24 th 9 am 3:30 pm

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1 HISTORY NC State Women s Soccer is a program that recently changed direction with a new Head Coach, Tim Santoro, in December It s a great time to make a major and immediate impact at an ACC program in the young and vibrant city of Raleigh, NC. We have a rich history: past NCAA finalist, ACC regular season and Tournament titles, 18 NCAA Tournaments, third most wins in ACC history (307), third most ACC titles in conference history, seven All-Americans, five Freshmen All-Americans, seven National Team members, one each National Freshman of year, Coach of Year, ACC Player of Year, ACC Tournament MVP and 30 All-ACC selections. FACILITIES We have the finest soccer training facility, not just the ACC, but in all NCAA Division I: the Wolfpack Training Center (WTC). For both the Men's and Women's soccer teams, WTC opened in Spring 2012 and features a grass field, a turf field, lights, 50-foot netting behind the goals and enclosed fencing with Wolfpack windscreen. The natural grass field is a replica of the Pack's game day field, the Dail Soccer Stadium. It is 120x75 yards, a USGA sand based field with hybrid Bermuda grass and a tile drainage system. The synthetic surface is 100x68 yards with FIFA certified infill system that is the first synthetic field on NC State's campus. A third area is extra turf space which features penalty box dimensions which can be used for set pieces, shooting on goal and GK training. There is also a 25,000 sq. ft. warm up/training area off that field as you enter the complex for the teams, an electronic gate so players can have access to train individually anytime, a storage area with equipment for them to use and top-of-the-line Kwik Goal goals and training equipment. WTC is located just across the street from the newly renovated Dail Soccer Stadium, with full Matrix board, upgraded press box, chair back seating, locker room building, new student bleachers behind both goals and international boards surrounding the field. Also, is adjacent Weisiger-Brown Athletic Building with the team's locker room and Sports Medicine facility. WOMEN S SOCCER ELITE ID CAMP Sunday, March 24 th 9 am 3:30 pm

2 REGISTRATION FIRST: LAST: ADDRESS: CITY/STATE/ZIP: REGISTRATION AND PAYMENT POLICY PRINT AND RETURN: 1) REGISTRATION FORM 2) MEDICAL FORM 3) WAIVER MAIL TO: WOLFPACK SOCCER SERIES 3264 RENAISSANCE PARK PLACE CARY, NC (919) REGISTRATION: CHECK BY MAIL $125 CHECK PAYABLE TO: WOLFPACK SOCCER SERIES D.O.B.: CELL: GRAD YEAR: CLUB TEAM: PARENTS/ GUARDIANS: SCHEDULE 8:30am ARRIVE/CHECK-IN 9:00-9:45am STRENGTH & CONDITIONING 9:45-11:30am TRAINING SESSION 11:30am-1:00pm LUNCH 1:00-3:30pm MATCHES 3:30pm - DEPARTURE APPLICATION POLICY Acceptance notices will begin going out March 10 and continue on a rolling basis until full. Applications will be accepted until March 20. A minimum number of campers is set at sixteen (16) and all accepted campers are advised to not book flight plans, if needed, until March 10 to ensure the minimum number is attained for this unique camp session. The camp is open to any and all entrants. DISCLAIMER: Elite ID Camp, a subsidiary of Wolfpack Soccer Series, LLC is neither owned, operated or sponsored by NC State University

3 WOLFPACK SOCCER SERIES MEDICAL FORM MEDICAL HISTORY, TREATMENT PERMISSION AND RELEASE NOTE: This form is required prior for participation in the Wolfpack Soccer Series, LLC. Participation will not be permitted until this form has been completed and signed and is on file with the Wolfpack Soccer Series, LLC. CAMP: WOLFIE KIDS CAMP DAY CAMP SPRING ELITE ID (May 11-12) SUMMER ELITE ID WINTER ELITE ID (March 24) PARTICIPANT INFORMATION: NAME: AGE: DATE OF BIRTH: First Middle Last HOME ADDRESS: Street Address City State Zip FATHER/GUARDIAN NAME: ADDRESS: PHONE: Home (_ ) Work (_ ) Cell ( ) MOTHER/GUARDIAN NAME: ADDRESS: PHONE: Home (_ ) Work (_ ) Cell ( ) OTHER/EMERGENCY CONTACT PERSON NAME: PHONE: Home (_ ) Work (_ ) Cell ( ) FAMILY PHYSICIAN: INSURANCE COMPANY: PHONE: ( ) ID NUMBER: MEDICAL HISTORY (Please use back of this sheet if necessary) DATE OF LAST TETANUS: BOOSTER: Is the participant under the care of a provider for a medical and/or psychological problem? NO YES If yes, please explain: Is the participant taking medication prescribed by a health care provider? NO YES If yes, please explain:

4 ALLERGIES If yes, please list the allergy and provide additional information if necessary. Insect bites/stings NO YES Medications NO YES Food NO YES Other NO YES RELEASE OF LIABILITY: I hereby release and discharge, indemnify and hold harmless the and Wolfpack Soccer Series, LLC, NC State University, and their members officers, agents, employees, and any other persons or entities acting on the behalf, and the successors and assigns for any and all of the aforementioned persons and entities, against all claims, demands, cost and expenses, and causes of action whatsoever, either in law or equity, arising out of or in any way connected with any property loss and/or bodily injury and/or disability, arising from my child s participation in the sports camp activities, including overnight stays on campus, if applicable. CONSENT FOR TREATMENT: I hereby give my permission to a Wolfpack Soccer Series, LLC certified athletic trainer to supervise on-site first aid for minor injuries. In the event of injury such as broken limb, sprain, contusion, laceration, concussion, etc., or illness requiring medical diagnosis or treatment, I hereby give my consent for Wolfpack Soccer Series, LLC staff to secure the proper medical care; including transportation and hospitalization, if necessary. Every attempt will be made to contact the parent or guardian to inform you of the need for any medical attention beyond minor first aid, if necessary. NOTE: Overnight stays on campus may be supervised by camp counselors and not certified athletic trainers. PHYSICAL EXAMINATION WITHIN ONE YEAR: I certify that within the past 12 months my child has had a physical examination by a physician and that he/she is physically able to participate in the sports camp activities. ASSUMPTION OF FINANCIAL RESPONSBILITY: I hereby acknowledge that I am responsible for medical charges incurred during Wolfpack Soccer Series, LLC participation. I further understand that the Wolfpack Soccer Series, LLC carries an excess medical insurance policy for sports injuries to the camper that may result from camp activities. Camp insurance has limits and exclusions and any secondary charges not covered under this plan will be my responsibility. This policy may only be utilized after my primary insurance company has processed the claims and issued an explanation of benefits.

5 IMPORTANT: MY SIGNATURE BELOW INDICATES THAT I HAVE READ AND UNDERSTAND THESE TERMS PRINT NAME:_ DATE: SIGNATURE:_ RELATIONSHIP TO PARTICIPANT: ADDITIONAL INFORMATION: PLEASE ATTACH A COPY (FRONT & BACK) OF HEALTH INSURANCE CARD BELOW

6 Wolfpack Soccer Series, LLC Waiver and Release Form Campers Name: Phone #: I understand the Wolfpack Soccer Series, LLC is not responsible for accidents occurring at camp or during camp transportation of participants to and from camp resulting in medical, dental, or other expenses, including the loss of personal items. The camp participants will be held responsible for all property damage and may be sent home without a refund for a violation of camp rules. The applicant must be in good health and be able to participant in the physical activity of a vigorous program. In the event that I cannot be reached, it is permissible for the Wolfpack Soccer Series, LLC to have a trainer, doctor and/or hospital treat my child for medical reasons. In addition, I grant Wolfpack Soccer Series, LLC permission to transport the above named child to and from training fields. Also, the undersigned individual and/or as parent or legal guardian of the above named child understands that this camp is not owned or operated by any of Wolfpack Soccer Series, LLC sites including, NC State University and do hereby agree to waive, release and hold harmless the NC State University, Wolfpack Soccer Series, LLC and its agents/employees from any and all causes including injury and property damage. Parent/ Guardian Signature: Date: Insurance Company: Policy Number: Group #: Special Medical Concerns:

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