PREP SOCCER REGISTRATION FORM
PREP SOCCER REGISTRATION FORM
________________________________
Last Name First Name
_______________________________________
Birth Date Grade in Fall 2016 Position
_______________________________________
Level Aspiring to play at in the fall
_______________________________________
Name of School Gender
_______________________________________
Street
_______________________________________
Town State Zip
_______________________________________
Email
_______________________________________
Parent/Guardian Name(s)
_______________________________________
Emergency Phone
Session (circle one):
1st ($275) 2nd ($275) Full ($425)
T-Shirt Size (circle one)
Adult : S M L XL
1 Order an additional shirt ($12 each) Y N
Player may be photographed Y N
Pursuant to state law, no player will be allowed to participate
until all forms are received. Registration is a first-come-first
-serve basis.
Complete & return this form with a signed
medical release and check to:
1 PREP Soccer Academy
11B Iona Street
Roslindale, MA 02131
2
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1 June 26th-August 4th
First Session: June 26 - July 14, 2017
(9 sessions)
Second Session: July 17 - August 4, 2016
(9 sessions)
Full Season: June 26 - August 4, 2017
(18 sessions)
Monday, Wednesday and Fridays
Newton South Stadium Turf Field
NOTE : No make up sessions will be available in the event of
weather-related cancellations.
2 CONTACT
Coach Jeff Katz :
Phone : 617-953-0630
Coach Roy Dow :
Phone : 617-417-1498
Online :
Email :
prepsocceracademy@
1 SCHEDULE
Field Players
Monday & Wednesday
30 min : Warm Up Phase
60 min : Game-Related Phase
30 min : Fitness/Injury Prevention
Friday
30 min : Warm Up Phase
60 min : Tournament Play
30 min : Fitness/Injury Prevention
Goalkeepers
Monday & Wednesday
60 min : Training w/ Goalkeeper Coach 30 min : Match Play
30 min : GK Specific Fitness/Injury Prevention
Friday
30 min : Warm Up Phase
60 min : Tournament Play
30 min : GK Specific Fitness/Injury Prevention
2 DESCRIPTION
Sessions will run from 6:00pm to 8:00pm, Monday, Wednesday and Friday evenings from June 27th to August 5th at the Newton South Stadium Turf Field.
3 GOAL
To provide an intensive environment for players to develop technical skills and establish a solid fitness base for the upcoming fall season. Our focus is on improving the player, NOT building the team. Team tactics vary with each coach’s philosophy, but the best players on every team are technically proficient, especially under high pressure. With 18 sessions over 6 weeks, Prep Soccer Academy staff will provide instruction and repetition to help players improve technique. Also, through the course of the summer we will gradually build players’ aerobic and anaerobic capacity in preparation for the fall season.
Finally, by inviting players from various high schools, we expect a good level of competition along with a sense of camaraderie.
3 COACHES
JEFF KATZ
MIT Women’s Soccer Assistant 2014-
Brookline Varsity Boys Head Coach 2002-2014
9 Division One State Tournament Appearances
2014 D1 North Semifinalists
2010 D1 North Finalists
2007 Bay State League Coach of the Year
2008 Eastern Mass Coach of the Year
2011 BHS Coach of the Year
NEFC Head Coach 2006-2014 (U15-U18 Girls)
CHSC Head Coach 2015- (U15 Girls)
USSF National D License
NSCAA National & Advanced National Diplomas
ROY DOW
Newton North Varsity Boys Head Coach 2010-
2010 Division One North Champions
2011 Division One State Tournament berth
F.C. Greater Boston Bolts U17 Coach
Tufts Men’s Soccer assistant coach 2007-2009
NSCAA Advanced National Diploma
NSCAA National Goalkeeping Certificate
USSF National B License
Former Wheaton College Player
KYLE BEAULIEU-JONES
Brookline Varsity Girls Assistant Coach
Former Brookline Freshman Boys Head Coach
F.C. Greater Boston Bolts U18 Boys Head Coach
NEFC U16 Girls Head Coach
NSCAA Advanced National Diploma
Former Wheaton College Player
JEN MILLER
Springfield College goalkeeper, captain
Soccer Watt Academy assistant goalkeeper coach 2006-2010
Assistant Director of goalkeeping Lightning Soccer Camps
2006-2010
Goalkeeper coach Austin Prep 2010
Head goalkeeper coach at Prep 2010-
Boxing Coach The Ring Boxing Club
TIM MASON
Wellesley High School Boys Varsity Head Coach. 2010 - present
4 consecutive Division 1 State Tournament appearances
2012, 2013, 2014 Herget Division Winners
Current Boston Breakers Coach (U16 & U17 NPL teams)
MPS Head Coach - 2008 - 2014 (U10 - U18 boys)
Winner of 2013 MA State Cup
Winner of 2010 US Club National Championship
Winner of 2010 US Club Regional Championship
NSCAA National Diploma (Distinguished pass)
3 year player at DeMontfort University
Academy player at Northampton Town and Rushden and Diamonds
EQUIPMENT
Players will need soccer cleats, sneakers/running shoes, shin-guards, a labeled soccer ball, water bottle, rain gear, a change of socks and a PREP Soccer Academy training jersey.
1 MEDICAL TREATMENT AUTHORIZATION
I hereby authorize the directors of PREP Soccer Academy to provide care and medical treatment as necessary to my child ____________________.
Physical conditions the staff should be aware of (allergies, reoccurring illness, disabilities, chronic illness, etc).____________________________
In the event an illness or injury requires more extensive treatment, I understand every reasonable attempt will be made to contact me. However, in the event I cannot be reached, I consent for the directors of PREP Soccer Academy to authorize any necessary treatment. I understand that family medical insurance must be used. PREP Soccer Academy does not provide medical insurance for players.
Family Physician Phone Number
Medical Insurance Co
Policy Number Group Number
I, the undersigned, individually and as a parent/guardian of : ____________________ a minor, ask that he/she be admitted to participate in PREP Soccer Academy. In consideration of such admission, I hereby agree to release, discharge and hold harmless, PREP Soccer Academy and the City of Newton from all causes, liabilities, damages, claims or demands whatsoever on account of any injury or accident involving said minor’s participation in activities held while attending PREP Soccer Academy.
Signature Date
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