Want to gain a competitive edge before your soccer season starts? Moore Soccer Academy is the answer! Jason's commitment to the growth of physical skills and mental keenness is paramount. They are dedicated to providing top level instruction and opportunities for Billerica residents to progress in their soccer abilities and deepen their passion and love for the game. Be sure to sign up for this soccer program hosted by Jason Moore is a retired American soccer midfielder who played in the MLS for teams such as New England Revolution (#16) in 2003, Chicago Fire, Colorado Rapids, LA Galaxy and won an MLS Cup Championship with DC United in his rookie year. Jason was the 1999 MLS number one draft pick out of the University of Virginia where he played two seasons and made it to a national championship. Other achievements include playing in the World Cup in Japan with the U.S. Team, and the 1996 Olympics, in Atlanta, GA. Shortly after Jason retired, he founded Moore Soccer Academy. His passion with helping youth at all levels and experience became his primary focus. Instructor: JASON MOORE SOCCER ACADEMY Location: AKESON FIELD Dates: 7/24-7/28/2017 Fee: $160.00 per person Session: 14005-A Time: 9:00-12:00PM Ages: 8-15 REGISTRATION FORM (Complete and return with any payments to: Billerica Recreation, 248 Boston Road, Billerica, MA 01862) JASON MOORE SOCCER ACADEMY Session: c 14005-A T-SHIRT SIZE: c Youth Small c Youth medium c Youth Large c Adult Small c Adult medium c Adult Large Participant’s Name Birth Date: Grade: Address State Zip_ Telephone (Day/Night) (Cell) E-mail: Special instructions and/or information that an instructor needs to be aware of: This is to certify that has my permission to participate in the program indicated above being conducted by the Billerica Recreation Department or its agents. I hold harmless any member of the Recreation Department or its agents from any and all injuries that might be sustained by the participant during the program. Further, this verifies that the participant is up to date with his/her immunizations and is able to participate in all activities. In the event of injury, I grant permission to provide/acquire medical care or assistance. By registering for a program, I give Billerica Recreation permission to take and publish photos of me or my dependent participating. Our pictures and our names may be used for promotional purposes. (Note: if you do not wish to be photographed, you must include this request in writing along with this registration) Signature of Adult/ Parent/Guardian Date Emergency Information: If we can not reach you at the number listed above, please call: Name _ Phone Number .