Valley Soccer Academy

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					                     Valley Soccer Academy
                                           Proudly presents
                            Indoor clinics at Christ Episcopal Church in Fairmont
                                      Two Four Week Programs

       Sundays 1st Program : Jan 25, Feb 1,8,15 -- 2ndProg: Feb 22 March 1,8,15

                  Roadrunner Soccer Age:5,6 Boys/Girls Cost $25/program
                                                 Time 1-2pm
                  Roadrunner Soccer Age:7,8 Boys/Girls Cost $25/program
                                                 Time 2-3pm
                   Daredevil Soccer Age: 9-10 Boys/Girls Cost $25/program
                                                 Time 3-4pm
                     Dynamics Ages: 11-14 Boys/Girls—Cost $50/program
                                        Time 4-5pm

      Call now or e-mail us to reserve spot on roster!!
                                     4-10 students per class
                      Mail Registration to : Valley Soccer Academy
                                 RR 4 Box 505A Fairmont, WV 26554
                    Make check payable to: Valley Soccer Academy
          For further information on all indoor events call: 304-669-5270
                                      Player Registration(Fair 09)


Road ( ) Dare ( ) 1st Program ( ) 2nd Program ( ) Time______________

I certify that my child is in excellent physical health and may participate in strenuous physical activities,
including soccer to be played at camp/clinic. Permission is granted for my child to receive emergency
medical treatment if needed. I hereby release said camp/clinic, Valley Soccer Academy/staff and Christ
Episcopal Church from any and all liability claims, for injuries or illness occurred while
attending/observing camp/clinic. I confirm that I am a parent/guardian of the minor named above.

Parent Name: Print_____________________________________________________

Parent/Guardian Signature:_____________________________________

E-mail(Please print clearly)_____________________________________

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