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2012 Spring & Summer, Camp & Training ProgramsEndorsements
“The most comprehensive technical
development program available worldwide”
Alan Pardew - Newcastle United Manager
www.Concept4SoccerUSA.comConcept 4 Soccer North America
47 Village Park Drive, Newnan, GA 30265
Tel - (678) 876-0437 E-mail - [email protected]
“In my opinion, it is the best way to improve the next
generation of players”
Sam Ricketts - Bolton Wanderers FC & Wales
“The development in our academy players technique
under Concept 4 Soccer has been excellent”
Tony Carr - West Ham United
“I would be happy to endorse the Concept 4 Soccer
International technical coaching program”
Garry Brazil - Premier League Youth Development Concept 4 Soccer North America Director is Simon Davey, a UEFA PRO LICENSE and former professional coach and player. Simon is
supported by UEFA A, UEFA B and USSF licensed coaches.
Spring Training Program6:00PM - 7:30PM April 20 - May 18, 2012
HomePlate, Peachtree City, GA$140 per player (6 sessions)/ $30 a session
Residential & Extended Day CampJuly 21 - July 25, 2012
The Riverside Military Institute
Gainesville, GA $425 - $525 per player
Advanced -Technical Skills Camp9:00AM - 12:00PM July 9 - July 13, 2012
Wall2Wall Sports Center
Roswell, GA$155 per player
Expert Induced Amnesia - What is it?
We take the players through the player learning
process to reach the stage where the skills become
automatic through ‘Expert Induced Amnesia’.
As the technical ability of a player is often the
difference between success & failure, can you afford not
to train with an internationally acclaimed and EPL Coach
endorsed program?
"The Concept 4 Soccer International technical coaching
program leads the way in producing players for the
future game"
Gary Monk - Swansea City FC Captain
Serving Sizes
Concept 4 Soccer is an international professional technical coaching program for youth soccer players and their coaches.
Concept 4 Soccer’s program has been internationally acclaimed and
recognized by federations, professional clubs and players. The program
was developed with Premier league academy players and is now being
delivered worldwide to elite and grassroots soccer players.
We are the only comprehensive, technical training program &
environment, that guarantees your player’s improve their technical
ability. Register on-line at www.Concept4SoccerUSA.com
What is Concept 4 Soccer?Concept 4 Soccer Registration FormConcept 4 Soccer Registration FormConcept 4 Soccer Registration FormConcept 4 Soccer Registration FormConcept 4 Soccer Registration FormConcept 4 Soccer Registration FormConcept 4 Soccer Registration FormConcept 4 Soccer Registration FormConcept 4 Soccer Registration FormConcept 4 Soccer Registration FormConcept 4 Soccer Registration FormConcept 4 Soccer Registration FormConcept 4 Soccer Registration FormConcept 4 Soccer Registration FormConcept 4 Soccer Registration FormConcept 4 Soccer Registration FormConcept 4 Soccer Registration FormConcept 4 Soccer Registration Form
Player Information (Please print)Player Information (Please print)Player Information (Please print)Player Information (Please print)Player Information (Please print)Player Information (Please print)Player Information (Please print)Player Information (Please print)Player Information (Please print)Player Information (Please print)Player Information (Please print)Player Information (Please print)Player Information (Please print)Player Information (Please print)Player Information (Please print)Player Information (Please print)Player Information (Please print)Player Information (Please print)
Name:Name: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
T - Shirt Size (Please circle)T - Shirt Size (Please circle)T - Shirt Size (Please circle)T - Shirt Size (Please circle)T - Shirt Size (Please circle) YS YM YL AS AM AL AXLYS YM YL AS AM AL AXLYS YM YL AS AM AL AXLYS YM YL AS AM AL AXLYS YM YL AS AM AL AXLYS YM YL AS AM AL AXLYS YM YL AS AM AL AXLYS YM YL AS AM AL AXLYS YM YL AS AM AL AXLYS YM YL AS AM AL AXLYS YM YL AS AM AL AXLYS YM YL AS AM AL AXLYS YM YL AS AM AL AXL
DOBDOB _______________________________________________________________________________________________ Age:Age: __________ Grade:Grade: _____________________ Sex M F
Program (Please Check): Program (Please Check): Program (Please Check): Program (Please Check):
Spring Training ($150) _____ Roswell Day Camp ( $155) ____Gainesville Extended Day ($425) ____ Residential Camp ($525) ____
Residential Team Camp/Early Bird Special (April 15th) ($475) ___
Spring Training ($150) _____ Roswell Day Camp ( $155) ____Gainesville Extended Day ($425) ____ Residential Camp ($525) ____
Residential Team Camp/Early Bird Special (April 15th) ($475) ___
Spring Training ($150) _____ Roswell Day Camp ( $155) ____Gainesville Extended Day ($425) ____ Residential Camp ($525) ____
Residential Team Camp/Early Bird Special (April 15th) ($475) ___
Spring Training ($150) _____ Roswell Day Camp ( $155) ____Gainesville Extended Day ($425) ____ Residential Camp ($525) ____
Residential Team Camp/Early Bird Special (April 15th) ($475) ___
Spring Training ($150) _____ Roswell Day Camp ( $155) ____Gainesville Extended Day ($425) ____ Residential Camp ($525) ____
Residential Team Camp/Early Bird Special (April 15th) ($475) ___
Spring Training ($150) _____ Roswell Day Camp ( $155) ____Gainesville Extended Day ($425) ____ Residential Camp ($525) ____
Residential Team Camp/Early Bird Special (April 15th) ($475) ___
Spring Training ($150) _____ Roswell Day Camp ( $155) ____Gainesville Extended Day ($425) ____ Residential Camp ($525) ____
Residential Team Camp/Early Bird Special (April 15th) ($475) ___
Spring Training ($150) _____ Roswell Day Camp ( $155) ____Gainesville Extended Day ($425) ____ Residential Camp ($525) ____
Residential Team Camp/Early Bird Special (April 15th) ($475) ___
Spring Training ($150) _____ Roswell Day Camp ( $155) ____Gainesville Extended Day ($425) ____ Residential Camp ($525) ____
Residential Team Camp/Early Bird Special (April 15th) ($475) ___
Spring Training ($150) _____ Roswell Day Camp ( $155) ____Gainesville Extended Day ($425) ____ Residential Camp ($525) ____
Residential Team Camp/Early Bird Special (April 15th) ($475) ___
Spring Training ($150) _____ Roswell Day Camp ( $155) ____Gainesville Extended Day ($425) ____ Residential Camp ($525) ____
Residential Team Camp/Early Bird Special (April 15th) ($475) ___
Spring Training ($150) _____ Roswell Day Camp ( $155) ____Gainesville Extended Day ($425) ____ Residential Camp ($525) ____
Residential Team Camp/Early Bird Special (April 15th) ($475) ___
Spring Training ($150) _____ Roswell Day Camp ( $155) ____Gainesville Extended Day ($425) ____ Residential Camp ($525) ____
Residential Team Camp/Early Bird Special (April 15th) ($475) ___
Spring Training ($150) _____ Roswell Day Camp ( $155) ____Gainesville Extended Day ($425) ____ Residential Camp ($525) ____
Residential Team Camp/Early Bird Special (April 15th) ($475) ___
Parent Information (Please print)Parent Information (Please print)Parent Information (Please print)Parent Information (Please print)Parent Information (Please print)Parent Information (Please print)Parent Information (Please print)Parent Information (Please print)Parent Information (Please print)Parent Information (Please print)Parent Information (Please print)Parent Information (Please print)Parent Information (Please print)Parent Information (Please print)Parent Information (Please print)Parent Information (Please print)Parent Information (Please print)Parent Information (Please print)
Name:Name: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Address:Address: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
City: _________________________________________________________________________________________________________ State:State: ________________________________________________________
Zip:Zip:Zip: _____________________________________________________________________
Emergency ContactEmergency ContactEmergency Contact
_____________________________________________________________________________________________________________________________________________________________________________________________ Phone:Phone:Phone:Phone: ________________________________________________________________________________________________________________
Simon Davey - Director for North America
Simon brings a wealth of top level playing and coaching experience to
Concept 4 Soccer International and will oversee the development of the
program for US coaches and players. Simon is one of only of three US
coaches to currently possess the highly esteemed UEFA Pro license. Apart
from coaching at a high level with Barnsley FC, Simon coached within and
managed the academy programs at Preston North End and Barnsley. In that
role, he developed the curriculum and oversaw the progress of youth soccer
players from the academy system to the professional level.
All coaches are UEFA, FA, USSF or NSCAA qualified and specially trained in the Concept 4 Soccer methodology to provide the ultimate experience in player development
Our StaffEmail Address: __________________________________________________________________________
(Important camp program information and receipts will be sent to your email address)
Payment Information (Please print)Payment Information (Please print)Payment Information (Please print)Payment Information (Please print)Payment Information (Please print)Payment Information (Please print)Payment Information (Please print)Payment Information (Please print)Payment Information (Please print)Payment Information (Please print)
Amount: $_______$_______ Payment Type (please circle)Payment Type (please circle)Payment Type (please circle)Payment Type (please circle)
Cash Check #: ______ Credit CardCash Check #: ______ Credit CardCash Check #: ______ Credit Card
Card Type: (Please circle)Card Type: (Please circle)Card Type: (Please circle)Card Type: (Please circle) VISAVISA MASTERCARDMASTERCARD AMEX DISCOVER
Credit card numberCredit card number Exp (MM/YY)Exp (MM/YY) CVV Code (3 digits on back / Amex 4 digits on front)CVV Code (3 digits on back / Amex 4 digits on front)
Cardholder Name (as it appears on card) Cardholders Address (if different from above)Cardholder Name (as it appears on card) Cardholders Address (if different from above)Cardholder Name (as it appears on card) Cardholders Address (if different from above)Cardholder Name (as it appears on card) Cardholders Address (if different from above)Cardholder Name (as it appears on card) Cardholders Address (if different from above)Cardholder Name (as it appears on card) Cardholders Address (if different from above)Cardholder Name (as it appears on card) Cardholders Address (if different from above)Cardholder Name (as it appears on card) Cardholders Address (if different from above)Cardholder Name (as it appears on card) Cardholders Address (if different from above)Cardholder Name (as it appears on card) Cardholders Address (if different from above)
Cardholder Signature Date: (MM/YY)Cardholder Signature Date: (MM/YY)Cardholder Signature Date: (MM/YY)Cardholder Signature Date: (MM/YY)Cardholder Signature Date: (MM/YY)Cardholder Signature Date: (MM/YY)Cardholder Signature Date: (MM/YY)Cardholder Signature Date: (MM/YY)Cardholder Signature Date: (MM/YY)Cardholder Signature Date: (MM/YY)
Parent Information (Please print)Parent Information (Please print)Parent Information (Please print)Parent Information (Please print)Parent Information (Please print)Parent Information (Please print)Parent Information (Please print)Parent Information (Please print)Parent Information (Please print)Parent Information (Please print)
Please include relevant medical information in writing with this application. I certify that my child(ren) above is / are in excellent health and are able to participate in physical activity, including soccer. I agree to hold Concept 4 Soccer USA, it’s agents, employees and contractors harmless from any and all claims for injuries sustained during my child(ren)’s participation in the program. Permission is granted for my child to receive emergency medical treatment.
Please include relevant medical information in writing with this application. I certify that my child(ren) above is / are in excellent health and are able to participate in physical activity, including soccer. I agree to hold Concept 4 Soccer USA, it’s agents, employees and contractors harmless from any and all claims for injuries sustained during my child(ren)’s participation in the program. Permission is granted for my child to receive emergency medical treatment.
Please include relevant medical information in writing with this application. I certify that my child(ren) above is / are in excellent health and are able to participate in physical activity, including soccer. I agree to hold Concept 4 Soccer USA, it’s agents, employees and contractors harmless from any and all claims for injuries sustained during my child(ren)’s participation in the program. Permission is granted for my child to receive emergency medical treatment.
Please include relevant medical information in writing with this application. I certify that my child(ren) above is / are in excellent health and are able to participate in physical activity, including soccer. I agree to hold Concept 4 Soccer USA, it’s agents, employees and contractors harmless from any and all claims for injuries sustained during my child(ren)’s participation in the program. Permission is granted for my child to receive emergency medical treatment.
Please include relevant medical information in writing with this application. I certify that my child(ren) above is / are in excellent health and are able to participate in physical activity, including soccer. I agree to hold Concept 4 Soccer USA, it’s agents, employees and contractors harmless from any and all claims for injuries sustained during my child(ren)’s participation in the program. Permission is granted for my child to receive emergency medical treatment.
Please include relevant medical information in writing with this application. I certify that my child(ren) above is / are in excellent health and are able to participate in physical activity, including soccer. I agree to hold Concept 4 Soccer USA, it’s agents, employees and contractors harmless from any and all claims for injuries sustained during my child(ren)’s participation in the program. Permission is granted for my child to receive emergency medical treatment.
Please include relevant medical information in writing with this application. I certify that my child(ren) above is / are in excellent health and are able to participate in physical activity, including soccer. I agree to hold Concept 4 Soccer USA, it’s agents, employees and contractors harmless from any and all claims for injuries sustained during my child(ren)’s participation in the program. Permission is granted for my child to receive emergency medical treatment.
Please include relevant medical information in writing with this application. I certify that my child(ren) above is / are in excellent health and are able to participate in physical activity, including soccer. I agree to hold Concept 4 Soccer USA, it’s agents, employees and contractors harmless from any and all claims for injuries sustained during my child(ren)’s participation in the program. Permission is granted for my child to receive emergency medical treatment.
Please include relevant medical information in writing with this application. I certify that my child(ren) above is / are in excellent health and are able to participate in physical activity, including soccer. I agree to hold Concept 4 Soccer USA, it’s agents, employees and contractors harmless from any and all claims for injuries sustained during my child(ren)’s participation in the program. Permission is granted for my child to receive emergency medical treatment.
Please include relevant medical information in writing with this application. I certify that my child(ren) above is / are in excellent health and are able to participate in physical activity, including soccer. I agree to hold Concept 4 Soccer USA, it’s agents, employees and contractors harmless from any and all claims for injuries sustained during my child(ren)’s participation in the program. Permission is granted for my child to receive emergency medical treatment.
Signed: _____________________________________ Date: __________________________ Signed: _____________________________________ Date: __________________________ Signed: _____________________________________ Date: __________________________ Signed: _____________________________________ Date: __________________________ Signed: _____________________________________ Date: __________________________ Signed: _____________________________________ Date: __________________________ Signed: _____________________________________ Date: __________________________ Signed: _____________________________________ Date: __________________________ Signed: _____________________________________ Date: __________________________ Signed: _____________________________________ Date: __________________________
There are four camp and program options available to you this season:
1) Spring - South Atlanta Technical Training Program - Apr 20 - May 18
2) Summer - Advanced Technical Skills Camp - July 9-13, 9:00am - 12:00pm
3) Summer - Extended Day Camp - July 21-25, 8:00am - 8:00pm
4) Summer - Residential Camp - July 21-25, Noon Sat - 1:00pm Wed
For multi-camp and sibling discounts register online at:
www.concept4soccerUSA.com