NH Soccer VA Adaptive Soccer Camp Registration

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VA Adaptive Soccer Camp Registration Injured Military veterans or members of the Armed Forces (PTSD, TBI, visual Impairment given preference) and workers providing supportive roles for veterans are invited to attend this 3 day soccer clinic. What you will experience:

1. Gain knowledge and training in adaptive soccer (CP/TBI Soccer and Blind Soccer)
2. Receive US Soccer Coach Grassroots Certification
3. Receive Mental Health First Aid Certification
4. Attend a fun community event
5. Exposure to alternative adaptive sport experiences
6. Lunch and dinner provided each day of camp
7. Lodging and transportation will be provided as needed and will be determined on a case-by-case basis

Main Goal

To introduce veterans to adaptive soccer and provide them with an opportunity to get a Coaching and Mental Health First Aid Certification. We will also provide resources for participants that want to get involved within their own communities after camp.Camp is limited to a maximum of 20 veterans and/or professionals. Register early!

For Questions and more information please contact
Ara Tamzarian
aratamzar@aol.com
603-512-5529

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First Name (on passport) * *

Last Name (on passport) * *

Date Of Birth (01/01/19XX) * *

شهر

YYYY

Address (street, city, zip) * *

Phone number (XXX) XXX-XXXX *

Email Address * *

Emergency Contact Name * *

Emergency Contact Phone Number (XXX) XXX-XXXX * *

% Service connected VA disability (for grant funding purposes) * *

Disability type for Soccer Identification ImpairmentPTSDOtherProfessional working with veterans (Rec Therapist, PT, OT, advocate etc.) *

CP/TBI/StrokeVisual

Visual Impairment

PTSD

Professional working with veterans (Rec Therapist, PT, OT, advocate etc.)

أخرى:

The Military Branch or unit you are/were involved with? *

Shirt Size (Adult Unisex) * *

xxl

أخرى:

Reason you would like to be included in this VA adaptive soccer camp and US Soccer Coaching Certification * *

Which of the following represents your current level of soccer knowledge/skills (select all that apply)? * *

I have no knowledge or previous experience in playing, coaching, or refereeing soccer.

I have basic knowledge of soccer (i.e., rules of the game, field positions, equipment requirements)

I am knowledgeable/skilled in playing soccer

I am knowledgeable/skilled in coaching soccer (i.e., planning + leading soccer practices related to athlete’s physical fitness, strength training, and soccer-specific drills)

I am knowledgeable/skills in refereeing soccer (i.e., i.e., rules of the game, personal fouls, penalties, etc.)

مطلوب

List any special accommodations that will be needed (eg. large print, food restrictions, pet friendly room, risk triggers, etc) * *

Will you commute to camp, or do you need a hotel room? * *

I will commute everyday

I need a hotel room (no extra fee; determined on a case-by-case basis)

أخرى:

But submitting this form, I understand, if selected, I am committed to be in attendance the full camp period and will complete the necessary coaching certification material provided PRIOR to attending the clinic * *

Yes, I understand this

No, please do not include me in this program as I am not 100% committed.

إرسال

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