Please fill out the form below to register with Massachusetts Youth Soccer. Please complete this form ONLY if you need to register as an "individual," that is, if you are not affiliated with any club or town team in Massachusetts. This form is simply for registration with Massachusetts Youth Soccer. It does not sign you up to play with any soccer team!
An example of who would complete this form is adults who are not currently affiliated with any town or club team but who are planning on taking coaching courses through Massachusetts Youth Soccer.
The following information refers to the REGISTRANT, that is, the person (player, coach, etc.) registering with Massachusetts Youth Soccer.
Individual Member Registration Form
Date of Birth (MM/DD/YYYY)
Address Line 2
Registering for Season
2014-2015 (current season)
Reason For Registering
Sign Me Up For
All Mailings (Commercial & Soccer)
Mass Youth Soccer Mailings Only
No Mailings At All
I, The Parent/Guardian of the registrant, a minor, (or, if the registrant is an adult: I, the selfsame as the registrant) agree that I and the registrant will abide by the rules of Massachusetts Youth Soccer, and US Youth Soccer, its affiliated organizations and sponsors. Recognizing the possibility of physical injury associated with soccer and it consideration for the Massachusetts Youth Soccer/US Youth Soccer accepting the registrant for its soccer programs and activities (the “Programs”), I hereby release, discharge and/or otherwise indemnify the Massachusetts Youth Soccer/US Youth Soccer, its affiliated organizations and sponsors, their employees and associated personnel, including owners of fields and facilities utilized for the Programs, against any claim by or on the behalf of the registrant as a result of the registrant’s participation in the Programs and/or being transported to or from the same, which transportation I hereby authorize.
I WILL ABIDE BY THE ABOVE RULES AND RELEASE
As Parent/Legal Guardian of (or selfsame as) the above named registrant, I hereby give my consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions are necessary to preserve life, limb, or well being of (me or) my dependent.
I GIVE CONSENT FOR MEDICAL TREATMENT
Note: The registration cost for the current season is $11 for each player and adult. Every adult who registers must also fill out a CORI form.
I agree to pay $11.00 in order to register as an individual with Massachusetts Youth Soccer. I understand that if payment is not made, I will not be registered.
INDIVIDUAL REGISTRATION FEE
Indicates Response Required