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Name ______________________________________________________

Age __________ q Male q Female

Address _____________________________________________________

City ________________________ State _______ ZIP code _____________

Phone ______________________________________________________

Current grade (as of Jan. 1, 2012) ______ Date of birth __________________

GOSHEN COLLEGE SOCCER CAMP 2012 APPLICATION

Acknowledgment of risk and assumption of personal responsibility:

I understand that during my participation in Goshen College Soccer Camp I will be exposed to above-normal risk. I understand, too, that although Goshen College and soccer camp personnel will take precautions to provide a safe environment, it is impossible to guarantee absolute safety. Also, I understand that I share responsibility for safety in the camp setting, and I assume that responsibility. I agree to verify with my physician that I have no physical or psychological problem that would prohibit participation in Goshen College Soccer Camp. I agree to comply with the instructions and directions of all camp directors and supervisors.

I have read the above statement and understand the nature of the physical demands of this activity. I therefore release any and all rights or claims for damages against Goshen College and camp personnel.

Participant signature ___________________________ Date __________

Parent/guardian signature _______________________ Date __________

Mail completed application to:

Goshen College Soccer Camp / Att: Tavi1700 South Main StreetGoshen, IN 46526-4794

A deposit of $50 must be sent with the application. The remaining fee must be paid by June 19, 2012. Make check or money order payable to Goshen College Soccer Camp. Registration after June 19 is $200.

T-shirt size:

q Youth M q Youth L

q Adult S q Adult M q Adult L q Adult XL

Are you interested in goalkeeper training? q Yes q No

Mid-Central Conference Champions – 18 timesNAIA District 21 Champions – 3 timesNAIA Regional VIII Champions – onceNAIA Men’s Soccer National Championship – 4 timesNAIA Academic All-Americans – 70 and counting

2012 GOSHEN COLLEGE

SOCCERCAMPJUNE 19-23

GOSHEN COLLEGE SOCCER CAMPS Tuesday, June 19 – Saturday, June 23, 2012

FOR: Kindergarten Kickers, 5-6 years oldBoys and girls, first through eighth grades

Thavisak (Tavi) Mounsithiraj, head coach of the Goshen College men’s soccer team, and a selected staff of quality coaches will provide a terrific learning environment for you. Come let the Maple Leaf soccer program improve your skill level. A fun-filled soccer experience gives you all the tools to become a better player!

In soccer, individual physical skills, teamwork, strategy and enjoyment combine for an engaging – and fun – sport that Goshen College has been practicing since soccer started here in 1958 and was highlighted by four trips to the NAIA National Tournament.

FIRST THROUGH EIGHTH GRADEDaily schedule:9:30 - 11:30 a.m. Technical and tactical training12 - 1:30 p.m. Lunch and relaxation2 - 3:30 p.m. Match play

KINDERGARTEN KICKERS (5-6 YEARS OLD)• For boys and girls finishing or entering kindergarten• Soccer FUNdamentals and games of all varieties• Parents encouraged to stay and watch• Cost: $65 • Daily schedule: 10-11:15 a.m.

PLACEThe Goshen College soccer facility, one of the best facilities in the state, has a lighted standard game field and four practice fields. Goshen College is located on State Road 15 (South Main Street) on the south side of Goshen.

PLAYING EXPERIENCENone is required; we train campers from beginners to Olympic development program to college caliber.

CURRICULUMCampers are trained in the proper techniques for shooting, heading, serving, dribbling, defending, passing and receiving.

GOALKEEPER TRAININGGoalkeeper training through instruction is offered in the technical, tactical, physical and mental aspect of advanced goalkeeping. This is recommended for anyone that is serious about goalkeeping. Goalkeeper training is under the direction of Illinois Wesleyan University Coach Tony Bauman.

COSTThe instructional fee for day camp is $175. Each additional family member will be only $150. A nonrefundable deposit of $50 must accompany the application with full payment by June 19, 2012. Registration after June 19 will be $200. GC Soccer Camp is a great value; compare it with other camps that can cost up to $250-$500. Cost includes lunch, official Goshen College soccer T-shirt and five days of soccer instruction.

INFORMATIONIf you have any questions regarding Goshen College Soccer Camp, please feel free to contact:Camp director – Thavisak (Tavi) Mounsithiraj574.535.7235 / thavisakm@goshen.edu

TIMESCamp will begin on Tuesday, June 19, at 1 p.m. for first through eighth grades, and on Wednesday, June 20, at 10:00 a.m. for Kindergarten Kickers. Camp will end on Saturday, June 23, at 11:30 a.m.

STAFFGoshen College Soccer Camp uses the best staff available, including current and former collegiate players from Goshen College and other schools across the country, and Goshen College graduates who now coach at the high school and college levels. Among them:

Thavisak Mounsithiraj – GC 1991-94• Goshen College men’s soccer coach• MCC Coach of the Year (2005)• NAIA Regional Coach of the Year (2006)• NSCAA Advanced National Diploma• NSCAA Level II Goalkeeper Institute

Thavisith “T” Mounsithiraj – GC 1990-93• Bethany Christian High School women’s soccer coach• NSCAA Regional Diploma

Tony Bauman – GC 1990-94• Illinois Wesleyan University soccer coach• NSCAA Advanced National Diploma• ISHAA State Champs and Coach of the Year 1999

GUEST CLINICIANS• Steve Smucker – Bluffton University (GC ’91)• Rick Nussbaum – Bluffton University (GC ’91)• Viratham “Coach V” Mounsithiraj – Goshen High School• Todd Woodworth – Northridge High School (GC ’78)