Annual Leadership Report

Member Organization
Location of Member Organization's Principal Office
Name and Contact Information for Executive Officers and Designated Directors of Member Organization
 NameAddressEmail AddressPhone Number
Vice President
Secretary/ Clerk
CORI Submitter/Risk Manager
Director of Soccer Development (DSD)
Organization's Participant Health and Safety Officer
By checking the boxes below and by submitting this Annual Leadership Report to Massachusetts Youth Soccer Association, Inc. I am certifying the following on behalf of the Member Organization named above.
I certify that I have the authority to submit this Annual Leadership Report on behalf of the Member Organization and to make the certifications herein. *
I certify that the Member Organization shall comply with the Massachusetts Youth Soccer Constitution, By-laws and all applicable Policies, Guidelines and Codes of Conduct as the same may be amended from time to time.  I certify that the Member Organization has adopted and will make public/provide Mass Youth Soccers' Codes of Conduct for Coaches, Players, Parents/Guardians/Spectators and Referees in addition to Mass Youth Soccer's Zero Tolerance Policy. *
I certify that all of the players, coaches, managers, administrators and other volunteer adults have or will be submitted by the noted deadlines to Massachusetts Youth Soccer for this soccer year and have met or will meet all of the requirements of Massachusetts Youth Soccer with regard to affiliation, playing age, educational/training requirements and criminal background checks by noted deadlines. *