PREP SOCCER REGISTRATION FORM



PREP SOCCER REGISTRATION FORM

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Last Name First Name

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Birth Date Grade in Fall 2016 Position

_______________________________________

Level Aspiring to play at in the fall

_______________________________________

Name of School Gender

_______________________________________

Street

_______________________________________

Town State Zip

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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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