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 - info@concept4soccerusa.com

“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.

www.Concept4SoccerUSA.cominfo@concept4SoccerUSA.com

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