DOMENIC
MEDIATE’S PROFESSIONAL SOCCER CAMP
ALL-STAR SPORTS ARENA SPRINGDALE,
ARKANSAS
Weekend Camp: ($100) Weekday
Camp: ($150)
December 19, 20 December
21, 22, 23
Ages 8-11: 10-2:30pm Ages 8-11: 8:30-1pm
Ages 12-15: 3-7:30pm Ages 12-15: 2:30-7pm
Introducing
the knowledge of:
Proper warm ups Nutrition
Speed/agility training Strength training
Technical tactical sessions Proper
cool downs.
Goalkeepers are welcome! If there is enough
interest, a professional goalkeeper will be flown in to handle your
sessions. Questions Contact: dmsoccertraining@aol.com
ARKANSAS REGISTRATION
FORM
Camper 1 ____________________________________________________________________________________
Circle Camp/Position: Weekend Weekday Field Player Goalkeeper
Circle Age: 8-9 10-11 11-12 13-15
Date of Birth__________________________________________Age________________Gender____________________
Camper 2 _____________________________________________________________________________________
Circle Camp/Position: Weekend Weekday Field Player Goalkeeper
Circle Age: 8-9 10-11 11-12 13-15
Date of Birth__________________________________________Age________________Gender____________________
Home Address________________________________________________________________________________
City__________________________________________State______________________Zip___________________
Mom’s
Name______________________________________________Phone____________________________
Dad’s
Name_______________________________________________Phone_____________________________
Best E-mail to Reach
Parent________________________________________________________________
Emergency Contact__________________________________________________________________________
Phone________________________________________________ Relationship__________________________
Please make check’s payable to Domenic Mediate. Total $ Enclosed_____________
220 Green Oaks Ln, Southlake, TX 76092
