NH Soccer VA Adaptive Soccer Camp Registration



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
First Name (on passport) * *
Last Name (on passport) * *
Date Of Birth (01/01/19XX) * *
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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.) *
The Military Branch or unit you are/were involved with? *
Shirt Size (Adult Unisex) * *
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)? * *
Required
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? * *
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 * *
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