DePaul Spring College Prep Clinic
DePaul Women's Soccer
Date: Saturday May 15th 2010
Time: 9 am- Noon
Location: Lincoln Park Turf Field
1778-1972 N John C Cannon Drive
Chicago, IL 60614
Access to the field is through the Lincoln Park Zoo
entrance. Players or parents are responsible for the parking rates that apply.
For High School players only. This one day clinic is designed for players
interested in playing collegiate soccer. Players will have the opportunity to
work exclusively with DePaul Women's Soccer staff. They will be exposed to a
high level training session that mirrors what we do on a daily basis.
Name: _______________________________________ Age/Grade: _______________________
Home Phone: _________________ Cell: __________________ Email: ____________________
Make checks payable to Chastain Soccer Academy.
Insurance Company: _______________________________ Provider: ________________________
Pre‐Exist. Condition: ____________________________________________________________________
Allergies: ________________________________________ Medication: ______________________
I hereby authorize the Staff of DePaul Girl's Soccer Camps to act for me according to their best judgment in any
emergency requiring medical attention and I hereby waive and release the camps and any DePaul personnel from any
and all liability for nay injuries or illnesses incurred while at the Camp. I have no knowledge of any physical
impairment that would be affected by the above named camper's participation in the Camp program, as outlines in
the brochure. I also understand that the Camp retains the right to use photographs of campers taken at the Camps for
publicity and advertising purposes.
Parent or Guardian's Signature: __________________________________ Date: ________________________