Certificate of Insurance Request Form

When organizations rent or reserve fields or facilities, the owner (e.g. town or facility owner) often asks for proof of insurance.  This form is used to request a Certificate of Insurance.  Only the President or the Registrar of an affiliated youth soccer organization can request a Certificate of Insurance from our office.

If you would like a General Certificate of Insurance that shows your organization is insured, please write "general" in the "Additional Insured to be Shown on Certificate" field.

The Certificate of Insurance will typically take 2-3 days to process, so please plan ahead!  The certificate CANNOT BE ISSUED if your organization is not properly affiliated with Massachusetts Youth Soccer for the current season.  

If you need more than one certificate, please DO NOT use your "back" button to return to the form.  Please return to the form through the "Resources" menu and be sure to refresh your browser when you open the form.  If you use your "back" button and do not refresh the form, your subsequent requests will not be submitted.

Please note:  This certificate is for games and practices involving the affiliated organization ONLY.  Massachusetts Youth Soccer's insurance coverage does NOT extend to any events run by for-profit organizations.  We will not provide this certificate unless your organization is affiliated with Massachusetts Youth Soccer. 

If you have any questions you can reach Rachel Woo at RWoo@mayouthsoccer.org or by phone at 978/466-8812 x236.

The Affiliated Organization is the soccer club or team which is affiliated with Massachusetts Youth Soccer (e.g. Adams Youth Soccer)
The Additional Insured to be shown on the certificate, that is, the name of the facility requesting the certificate.
We cannot process a Certificate for an Additional Insured without a mailing/street address!
* Indicates Response Required