Permission to Travel to a US Youth Soccer or USASA Sanctioned Event

* Person Completing Form:

Coach

Team Manager

* First Name:

* Last Name:

* E-mail Address:

* Street Address:

* City:

* State:

* Zip:

* Home Phone (w/area code):

* Work Phone (w/area code):

* Team Name:

* Club Name:

* Team Number:

* Age Group:

* Team Gender:

Male

Female

Coed

* Team Type:

* Tournament Attending:

Tournament or Event Website:

* City of Tournament:

* State of Tournament:

* Tournament Affiliation:

* Dates of Tournament:
(e.g., September 4-5, 2010 )

*Please note that every team must have an OSA approved roster before traveling.

* Indicates Response Required