City 6 Girls Soccer Clinic for Officer John Pawlowski


City 6 Soccer Girl’s Clinic
Drexel, La Salle, Penn, Saint Joes, Temple and Villanova Women’s Soccer Teams
All Proceeds go to:
John Pawlowski Family Memorial Trust Fund
(John’s wife Kimmy Pawlowski played for SJU)
When:            April 4th, 2009 1-2:30pm, 12:30pm Registration
Where:                       Finnesey Field, Saint Joseph’s University
Who:               Ages 6-17/ All levels (You are grouped according to age
and ability.)
Refresh your skills or learn new skills to enhance your ability.
Female Collegiate Players as Role Models.
Small coach to player ratio about 1:7.
Keeper training for those interested.
Help out a good cause.
11am-12pm                 Saint Joseph’s VS La Salle
12-1pm                                    Saint Joseph’s VS Temple
12:30-1pm                   Clinic Registration
1-1:10am                     Opening Ceremonies
1:10-1:20pm                Foot skills and juggling-warm up and stretching
1:20-2pm                    Stations- Finishing, defending, coervers and 1v1’s, possession,                                       passing and receiving, long balls and receiving air balls. 
2-2:20pm                    Small Sided Games
2:20-2:30pm              Closing Ceremonies
Cost: $25.00 Donation
You must bring: Water bottle, shinguards, cleats.
Come Early to Catch Some City 6 Teams in Action 9am-1pm
Any questions please contact Coach Jess Reynolds  at 610-660-3367 or email
Please complete and mail along with the check to:
City 6 Soccer Clinic
Attn: Jess Reynolds
Saint Joseph’s University
5600 City Avenue
Philadelphia, Pennsylvania 19131-1395
Please make all checks payable toJohn Pawlowski Family Memorial Trust Fund
Thanks for your support!
Name:_________________________     Age:_______     Grade:_______
City:___________________________     State:___________     Zip:__________
Phone Number:___________________     Email:___________________
Soccer Experience:_____________________________________________________
Waiver Form
Since all campers will be under the age of 18, this waiver must be signed by the child’s parent or guardian.
I understand City 6 Soccer, its staff and employees, and the City 6 Soccer clinic staff are not responsible for any accident or injury occurring to(child)____________________while attending camp
Parent/Guardian Signature
Please list any pertinent medical information of which our staff should have knowledge.
Authorization to consent to medical treatment for a minor child
I, (parent/guardian)____________________, state that I am the natural parent and/or have legal custody of(child’s name)____________________.
I authorize ____________________ head coach and clinic director, to consent to any examination, anesthetic, xray, medical or surgical diagnosis or treatment, and/or hospital care to be rendered to this minor under the general conditions of special supervision and on the advice of any physician or surgeon licensed to practice when efforts to contact me are unsuccessful. This consent form is granted for the period of______________________.
Parent/ Guardian Name:_____________________________________
Parent/ Guardian Signature:__________________________________
Date:________________   Emergency Phone Number:___________________________
Medical Insurance Carrier_________________________________________________
Insurance ID #_____________________ Carrier Phone #________________________