Soccer Vision Academy- Summer Soccer Camp -

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					                        Soccer Vision Academy- Summer Soccer Camp
                                July 19-23, 2010 5:30 -8:30 PM
                               Sponsored by Belpre Soccer Club
                                                For Ages 5 through 17
                      Soccer Vision Academy Director - Anthony James
                                               Facts about Anthony James

            USSF “A” License                                                     Head coach of SVA U-10 and U-11 Boy’s
            NSCAA Premier Diploma                                                 teams
            USSF Youth License                                                   Assistant staff coach with the US Under-14
            Spent time studying and viewing Real                                  Girl’s National Team
             Madrid Youth Academy in Spain                                        Head coach of the 1995 Girl’s Ohio North
            Founded Soccer Vision Academy in 1998 in                              ODP state team
             Wheeling, West Virginia with the goal to                             Senior Staff Coach Olympic Development
             further develop the youth players in the                              Program Region I Girls teams
            Head Coach for Youngstown State University                           Assistant Coach for Wheeling Jesuit College
             Coach for WV Wesleyan College                                        WV HS Soccer Coaches Assoc. Coach of
            Head Coach for Wheeling Park High School                              the Year in 1999
            WVIAC Coach of the Year 01 & 03


   Name:                                                              Email:
   Address:                                                           Phone:
   Address:                                                           Male ________ Female ________
   DOB: _____/_____/_______                                           T-shirt size: YS YM YL YXL AS AM AL AXL
   Insurance Co.

Make checks payable to Belpre Soccer Club, Payments must be received by July 15, 2010.
$100 Registration fee includes Tshirt, $10 discount for siblings and $75 per child for a team of 12
players or more. Mail Registration to: Belpre Soccer Club P.O. box 157 Belpre, Ohio 45714
                                       For all questions, contact Jessica Barrett
                                      304- 893-1377 or

I hereby give the above applicant permission to participate in all Soccer Vision Academy training. In case of emergency, I authorize
the instructor to act on my behalf if my son or daughter was given emergency treatment. I release the academy staff and directors of
any injury or illness to my child during training and agree to hold Soccer Vision Academy harmless from any claims.

Parent’s Name:________________________________________                         Date: __________________________________ and

               Beginning June 1st online registration and payment can be completed at

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