Health Details

Bascome Pro Soccer Clinic 2015

Your childs health is important to us, if there are any medical conditions relating to your
child please explain below.
Does your child have allergies?

m Yes (Please explain below) m No

Are there any other medical conditions we should be made aware of?

m Yes (Please explain below) m No

Pro Soccer Clinic 2015

Clinic 1 June 29 - July 3 Clinic 2 August 17 - August 21

North Field, National Sports Centre
Males and Females | Ages 4 - 16
Kiddy Kickers Group
(Coed Clinic)

4 - 5 years
6:00pm - 7:00pm

Basic Group

(Male and Female Groups)

6 - 10 years
6:00pm - 8:00pm

Bridge to Success

(Male and Female Groups)

9 - 16 years
6:00pm - 8:00pm

History...The Pro Soccer Clinic, founded by

Bascome/Goater Pro Soccer, sponsored by Validus,
has had more than 6,000 participants over the past
24 years. Look out for the new Pro Soccer Clinic
logo in the year to come and stay connected
with us at www.bascomeenterprise.com!

Pro Soccer Clinic 2015

Registration Form - Bascome Pro Soccer Clinic 2015

To confirm your childs registration please submit the completed registration form and fee in the drop box
located at Sportseller, in the lower level of the Washington Mall. The deadline to register: Clinic 1 - June 19;
Clinic 2 - August 7. You will only be contacted if the clinic reaches its maximum capacity and your application
can not be accepted. If you are not contacted your childs registration is confirmed.

Players Name

Please print ALL information clearly

m Male m Female

Address

Please print ALL information clearly

Postal Code

Date of Birth day | month | year

Age

Parent/Guardian Name Please print ALL information clearly

Telephone (home)

(work) (cell)

Email
Payment Methods
m Cash m MasterCard

m Visa m Check

Make all checks payable to Bascome Enterprise

Credit Card Information

Name on Card

Cardholder name and signarture MUST match.

Signature of Cardholder
Card Number

Expiry Date

month | year

Kiddy Kickers Group 4 - 5 years (Coed) 6:00pm - 7:00pm

m Clinic 1 or m Clinic 2 | m Clinic 1 & Clinic 2
m $30.00 (before deadline) m $35.00 (after deadline) | m $50.00 (Clinic 1 & 2) m $55.00 (after deadline - Clinic 1 & 2)
Participating Parent/Guardian Name

Please print ALL information clearly

Basic Group 6 - 10 years (Male and Female Groups) 6:00pm - 8:00pm

m Clinic 1 or m Clinic 2 | m Clinic 1 & Clinic 2 | m Male m Female
m $70.00 (before deadline) m $75.00 (after deadline) | m $130.00 (Clinic 1 & 2) | m $135.00 (after deadline - Clinic 1 & 2)
If the player is 9 or 10 years old they have the option to participate in the Basic Group and/or Bridge to Success.

Bridge to Success 9 - 16 years (Coed) 6:00pm - 8:00pm

m Clinic 1 or m Clinic 2 | m Clinic 1 & Clinic 2 | m Male m Female
m $70.00 (before deadline) m $75.00 (after deadline) | m $130.00 (Clinic 1 & 2) | m $135.00 (after deadline - Clinic 1 & 2)
If the player is 9 or 10 years old they have the option to participate in the Basic Group and/or Bridge to Success.
As a parent/guardian of the child registered for the Bascome Pro Soccer Clinic 2015, I certify that the participant(s) are in excellent
physical health and capable of participation in the Bascome Pro Soccer Clinic 2015. I hereby agree to waive all costs, damages, losses
and expenses of any kind whatsoever resulting from or in connection with the activities in which my child undertakes as a participant of
the Bascome Pro Soccer Clinic 2015 and indemnify and hold harmless the coaches, staff, organisers, supervisors and sponsors of the
Bascome Pro Soccer Clinic 2015. I grant permission for my childs picture to be taken or appear in video for promotional materials
created and published to promote the Bascome Pro Soccer Clinic and the programmes partnership with sponsoring organisations.
Parent/Guardian Signature

Date

Does your child have any allergies or physical challenges you feel we should be made aware of?
If yes, please explain on reverse side of this registration form. m Yes m No

The Coaches

Bascome Pro Soccer Clinic 2015

Kiddy Kickers

David Bascome

Hometown: Bermuda
President of Bascome Enterprise
MISL Professional and Assistant Coach for Baltimore Blast

Mike Williams, Pro Soccer Clinic Clinic Director

Hometown: Washington D.C.

Vice President of Bascome Enterprise
Former Professional Outdoor/Indoor Player, Professional College Scout

Danny Kelly

John Barry Nusum

Jonatas Melo

William Vanzela

Kati Jo Spisak

Danielle Malagari

Hometown: Baltimore, Maryland

MISL Professional and
Head Coach for Baltimore Blast

Hometown: Brazil
Professional Player for Baltimore Blast

Hometown: Germantown, Maryland

USA Professional Womans Coach

Hometown: Bermuda
Former Professional and Youth Coach

Hometown: Brazil
Professional Player Baltimore Blast.
Italys National Fut Goal Keeper

Hometown: Germantown, Maryland

USA Professional Womans Coach

Dante Leverock

Hometown: Bermuda
Pro Soccer Clinic Assistant,
Profesional Player Harrisburg City Islanders

Keishun Smith

Hometown: Bermuda
Youth Coach, Premier Team Coach

Proudly sponsored by

Kevin Simpson

Hometown: Bermuda
Youth Coach

The Kiddy Kickers programme, a starter clinic for players ages 4 & 5 years
old introduces them to the FUN-damentals of soccer. A parent or guardian
must accompany each player for the entire daily one hour training session.
Players will be taught basic soccer skills and fun drills. This is a chance for
parents to get actively involved!

Basic Group

Open to male and female players ages 6 - 10 years the Basic Group
provides players with the opportunity to build on their soccer skills and be
taught the importance of positive discipline and becoming team players
both on and off the field. Participants will be taught by qualified
coaches and experienced players. Male and female players will
be in separate groups.

Bridge to Sucess

Open to male and female players ages 9 to 16 years,

the Bridge to Success programme will
give players the tools to become the
model player. In addition to providing
players with the opportunity to build on their
soccer skills, learning positive discipline and becoming
team players on and off the field, participants will focus on
overall technique, the value of possession, their values as
players and participate in blackboard/life skills sessions.
At the end of the week each player will be evaluated
to ensure they have learned and understood the
importance of the information they received.
Players will then be selected to receive a
scholarship to the Validus Power of One camp.
Areas are Game Awareness,
Health and Fitness and Social Conduct.

Training Schedule

The Specifics
Clinic 1 June 29 - July 3
Clinic 2 August 17 - August 21
Kiddy Kickers Group | Basic Group | Bridge to Success

Kiddy Kickers Group

Venues
North Field, National Sports Centre, Roberts Avenue, Devonshire DV01

Monday - Thursday | 6:00pm - 7:00pm | Coed Soccer Clinic

Age Groups
4 - 5 years Kiddy Kickers Group - Coed
6 - 10 years Basic Group Males | 6 - 10 years Basic Group Females
9 - 16 years Bridge to Success Group Males | 9 - 16 years Bridge to Success Group Females
Attire
Basic Group/Bridge to Success Soccer boots | Shin Guards | White Socks | White Shorts | White Tshirt
Kiddy Kickers Group Youth and adult participants may wear sneakers instead of soccer boots.
Adult participants in the Kiddy Kickers Group do not have to wear white attire. All Pro Soccer
Clinic participants will receive a Tshirt. Tshirts must be worn for group photos.
Clinic Capacity per week
48 males and females total maximum players for Kiddy Kickers Group
200 males and females maximum players for Basic Group
100 males and females total maximum players for Bridge to Success
Registration | Orientation | Fees
Clinic 1 June 29 - July 3
Registration deadline: June 19

Orientation
Saturday, June 27th 4:00pm - 6:00pm
North Field, National Sports Centre Clubhouse

Clinic 2 August 17- August 21

Registration deadline: August 7

Orientation
Saturday, August 15th 4:00pm - 6:00pm
North Field, National Sports Centre Clubhouse

Fees
Fees
Kiddy Kickers
Kiddy Kickers
$30.00 one clinic | $50.00 both clinics
$30.00 one clinic | $50.00 both clinics
$35.00 and $55.00 (after deadline)
$35.00 and $55.00 (after deadline)
Basic Group
Basic Group
$70.00 one clinic | $130.00 both clinics
$70.00 one clinic | $130.00 both clinics
$75.00 and $135.00 (after deadline)
$75.00 and $135.00 (after deadline)
Bridge to Success
Bridge to Success
$70.00 one clinic | $130.00 both clinics
$70.00 one clinic | $130.00 both clinics
$75.00 and $135.00 (after deadline)
$75.00 and $135.00 (after deadline)
Mandatory pick up of Tshirt, water bottle, clinic specifics and group assignment.
Registration Options
Drop Box located at Sportseller, located in the lower level of the Washington Mall.
Complete an application form, with payment (check, cash, Visa or MasterCard) and drop in box.
Make all checks payable to: Bascome Enterprise
Registration Confirmation
To confirm your childs registration please submit the completed registration form and fee
Monday - Friday, 9:00am to 4:30pm by registration deadline dates listed above. You will only be
contacted if the clinic reaches its maximum capacity and your application can not be accepted.
If you are not contacted your childs registration is confirmed.
Pro Soccer Contact
Jakisha Douglas, Pro Soccer Clinic Administrator
Tel +1 441 747 5589 | Email prosoccerclinic@gmail.com
Website www.bascomeenterprise.com

Clinic 1 June 29 - July 3

Clinic 2 August 17- August 21

Friday | 6:00pm - 7:00pm

6:00pm - 7:00pm | Coed Soccer Clinic
7:00pm | Presentation
Photos will be taken. Pro Soccer Clinic Tshirts to be worn by all participants.

Basic Group
Clinic 1 June 29 - July 3

Clinic 2 August 17- August 21

Monday - Thursday | 6:00pm - 8:00pm | Soccer Clinic (Male and Female groups)
Wednesday | 7:30pm - 8:00pm | Soccer Tennis Tournament (Parent participation)
Friday | 6:00pm - 7:30pm
6:00pm - 7:30pm | Skills Competition
7:30pm | Presentation
Photos will be taken. Pro Soccer Clinic Tshirts to be worn by all participants.

Bridge to Success
Clinic 1 June 29 - July 3

Clinic 2 August 17- August 21

Monday - Thursday | 6:00pm - 8:00pm | Soccer Clinic (Male and Female groups)
Soccer Clinic (functional ball work and fitness training)
Blackboard work/life skills sessions (health, social talk and game awareness teaching)
Training on field (value of possession and game awareness)
Friday
6:00pm - 7:30pm | Basic Skills Competition
7:30pm | Presentation
Photos will be taken. Pro Soccer Clinic Tshirts to be worn by all participants.