Individual Youth Member Registration Form Winter/Summer Only Player

Please fill out the form below to register a youth player with Massachusetts Youth Soccer. Please complete this form ONLY if you need to register a child 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 a player who needs to become a member in order to sign up for a training course, approved winter play, approved summer camps/clinics or a tournament.

If you are an adult who is registering with Massachusetts Youth Soccer, please use the Adult Member Payment Form.

The following information refers to the REGISTRANT, that is, the player registering with Massachusetts Youth Soccer.

Are you registering as a youth member
or as an adult member? *

Youth

If you are registering as an adult member,

please use the Adult Member Payment Form

First Name *

Last Name *

Date of Birth
(DD/MM/YYYY) *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *

Organization Name

Registrant's Gender *

Registrant Type *

Player

Registering for Season *

2023-24 (current season)

Reason For Registering *

In consideration of my child, or myself as an adult, being allowed to participate in any way in the soccer programs and activities of USYouth Soccer and its members (e.g. Massachusetts Youth Soccer Association and its member organizations), andtheir related events and activities (the “Programs”), the undersigned, acknowledge, appreciate, and agree that:

The risk of injury and illness from the activities involved in the Programs is significant, including (without
limitation) the potential for injury or illness – in particular and not by way of limitation, risks of exposure, directly or indirectly, arising out of, contributed to or by, or resulting from any infectious or communicable disease, including (without limitation) the current or any future outbreak of the novel coronavirus (COVID-19) and/or any mutation or variation thereof – and while particular skills, equipment and personal discipline may reduce this risk, the risk of serious injury or illness does exist. I knowingly and freely, for myself and on behalf of my child, or myself as an adult, assume all such risks, both known and unknown, even if arising from the negligence of the Releasees or others, and assume full responsibility for my and my child’s participation in the Programs.

I consent to my child, or myself as an adult, participating in the Programs.

I, for myself and on behalf of my child, and our respective heirs, assigns, personal representatives and next of kin, hereby release, indemnify, and hold harmless US Youth Soccer, its member organizations (e.g. Massachusetts Youth Soccer Association and its member organizations), and their respective directors, officers, employees, agents, associated personnel, volunteers, other participants, sponsoring agencies, sponsors, advertisers and, if applicable, owners and lessors of fields, facilities and premises utilized for the Programs (collectively, the “Releasees”), with respect to any and all injury, illness, disability, death or loss or damage to person or property associated with my or my child’s presence at, or participation in the Programs, including being transported to or from the Programs, whether arising from the negligence of the Releasees or otherwise, to the fullest extent permitted by law.

I hereby authorize the transportation of my child, or myself as an adult, to or from the Programs.

My child, or myself as an adult, has received a physical examination by a licensed medical doctor and has been found physically capable of participating in the sport of soccer. I have provided written notice attached to this release setting forth any specific issue, condition, or ailment that my child has that may impact my child's, or myself as an adult, participation in the Programs.

I give my consent to have an athletic trainer and/or licensed medical doctor or dentist provide my child, or myself as an adult, with medical assistance and/or treatment and agree to be financially responsible for the reasonable cost of any such assistance and treatment.

When necessary, I understand that an uploaded or provided photo will only be used for printing on a credential (i.e., ID, Pass Card, Roster) and will not be used for any other purposes without express consent. I consent to Massachusetts Youth Soccer and its affiliates taking photographs, video recordings, and/or sound recordings in documenting the activities of Massachusetts Youth Soccer’s programs and services. I hereby grant Massachusetts Youth Soccer and its affiliates’ permission to use the negatives, prints, motion pictures, video recordings, audio recordings, or any other reproduction of the same for Massachusetts Youth Soccer and its affiliates’ educational and promotional purposes in manuals, on flyers, the internet, or other publications.

Myself as an adult or my child and my child’s parents and guardians will abide by the rules, policies, procedures and protocols as provided by U.S. Youth Soccer and members of U.S. Youth Soccer, including Massachusetts Youth Soccer and all affiliated member organizations.

I understand and give permission for my child, or myslelf as an adult, to participate in practices and games where they may be on the field with players of younger or older ages. I understand and accept there may be risks involved when playing with players of different ages. I am aware that if I do not accept such risks I may remove my child, or myslelf as an adult, from the field.

I have read this release of liability and assumption of riskagreement, and fully understand its terms. I understand that I have given up substantial rights by electronically signing this document, and I sign it freely and voluntarily without any inducement. I hereby waive all such rights above including the right to file a legal action or assert a claim for personal or physical injury or death of any kind. *

I WILL ABIDE BY THE ABOVE RULES AND RELEASE

I agree to pay $22.00 for year round approved soccer play, $11.00 for winter activities only (i.e. indoors, futsal), or $11.00 for summer clinic and camp activities only, in order to register as an individual player with Massachusetts Youth Soccer. I understand that if payment is not made, I will not be registered nor covered by any Mass Youth Soccer insurance policies. *

INDIVIDUAL REGISTRATION FEE Full Year

INDIVIDUAL REGISTRATION FEE Winter Only

INDIVIDUAL REGISTRATION FEE Summer Only