Certificate of Insurance Request Form

When organizations rent, lease 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.  You must submit form(s) with name of location and address.   Only the President or the Registrar of an affiliated youth soccer organization can request a Certificate of Insurance from our office.

"Additional Insured to be Shown on Certificate" field:  Enter the legal name of the field owner.  If you would like a General Certificate of Insurance that shows your organization is insured, write "general" in this field.  A General Certificate can not be used for field usage.

If this form is properly completed the Certificate of Insurance will typically take 2-3 days to process, so please plan ahead!  Improperly completed forms will not be processed and you may not be notified for at least 7 days.
 
The certificate CANNOT BE ISSUED if your organization is not properly affiliated with Massachusetts Youth Soccer for the current season. This requires player data upload, fee submission form and payment for that season.  If this is for the Winter or Spring season and there will be no changes of additional players, email Rachel Woo at the email address below.

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 from the Certificate of Insurance web site page, not the form page, 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. Insurance coverage does NOT extend to any events not sanctioned or acknowledged as approved for coverage by Massachusetts Youth Soccer.  We will not provide this certificate unless your organization is properly 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 league which is properly 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 field / site owner requiring the certificate.
We cannot process a Certificate for an Additional Insured without a mailing/street address!
Only the President or the Registrar of an affiliated youth soccer organization can request a Certificate of Insurance from our office