NORTH SALEM RECREATION
RON HENDRIE’S 2019 SOCCER ACADEMY
AUGUST 5 THROUGH AUGUST 9
AT THE NORTH SALEM HIGH SCHOOL
 

Boys and girls ages 3 – 15 will learn soccer skills, tactics, and good sportsmanship while having fun!

Director: Ron Hendrie, “2008 National Coach of the Year”, and North Salem Varsity Boy’s Soccer Coach, has both the NSCAA Advanced National & Dutch National Coaching Diplomas as well as NYSPHSAA coaching certification.



For ages 3 and 4, the fee will be $140 before June 1st. The fee after June 1st will be $170. This program will run from 9:00am – 10:30am.


For grades K-9, the fee will be $190 before June 1st. The fee after June 1st will be $220. This program will run from 8:30am – 12:30pm.



Participants will receive a soccer ball, t-shirt, and daily accomplishment awards.

 

 

NORTH SALEM RECREATION DEPARTMENT
HENDRIE’S SOCCER ACADEMY
Name: _______________________________________________Grade (Sept. 2019): _________________
Address: _______________________________________________________________________________
Phone #_____________________________________ Cell#______________________________________
Email Address:__________________________________________________________________________
Please list any medical conditions that might be a problem when playing this sport: _____________________
________________________________________________________________________________________
________________________________________________________________________________________________
EMERGENCY CONTACT – Name: ________________________ Relationship to child: _________________
Phone # _____________________ Cell # __________________
As the parent/guardian of _____________________________(print child’s full name) I, ________________________(print parent’s
full name) do fully understand and acknowledge that soccer is a contact sport accompanied by an inherent risk of injury, or in extreme cases paralysis or death. I further understand that participating in Hendrie’s Soccer Academy may, at times, involve my child competing against children who are larger, stronger and faster due to age and/or gender differences and that this increases the likelihood and severity of these risks. In light of these considerations, I hereby assume whatever risks are involved and give my
consent for my child to participate in every activity of the academy. Furthermore, I represent that my child’s physical and emotional
fitness are at an adequate level to participate in this athletic endeavor.

In addition, I hereby hold Hendrie’s Soccer Academy, its volunteers, affiliates, employees, and representatives harmless from any and all claims, injuries, damages, and liabilities sustained or incurred in connection with my child’s participation in any Hendrie’s Soccer Academy activity or use of facilities.

 

I understand that Hendrie’s Soccer Academy does not carry insurance for hospitalization or medical costs and will not provide
coverage for persons injured while participating in this program. I, therefore, agree to seek reimbursement through my own insurance and I assume the entire responsibility for what my insurance provider does not cover.

 

Hendrie’s Soccer Academy maintains the right to utilize any photographs or video recordings of the campers participating at camp to be used for advertising and/or publicity purposes.

Hendrie’s Soccer Academy is not responsible for any damaged, lost or stolen property.

​

I have read and understand the Cancellation/Refund Policy as outlined on a separate document.

By signing this consent form, I am acknowledging that I have read, understand and accept it in its entirety.

(PARENTS/GUARDIANS OR ATHLETES WHO DO NOT WISH TO ACCEPT ALL OF THE RISKS, TERMS, AND
CONDITIONS DESCRIBED IN THIS WARNING SHOULD NOT SIGN THIS CONSENT FORM.)

Parent/Guardian Signature _____________________________________ Date: __________________

Town of North Salem Waiver: I hereby release the Hendrie’s Soccer Academy, the Town of North Salem, it’s officials, employees
and volunteers of any liability whatsoever in connection with any damages and or injuries that I or any of my family may sustain as a result of participation in the programs of the North Salem Recreation Department. A full refund will be given if the Recreation
Department cancels this program. All participate at their own risk. The Town of North Salem does not carry insurance to cover
hospitalization or medical costs of persons injured while participating in any Recreational Programs.
Parent/Guardian Signature _____________________________________ Date: __________________