ID Verification Form - Mass Youth Soccer Adult Registration

Full Name of Organization (No Acronyms) you will be participating with; if more than one, please list all. *

Please select all roles you have within the organization(s).

Legal Last Name *

Legal First Name *

Middle Initial

Suffix

Street Address *

Address Line 2

City *

State *

Zip Code *

Email Address *

Phone Number *

DISCLOSURE - Prior to participating in any Mass Youth Soccer related activities you are required to be in full compliance with all Mass Youth Soccer adult risk management requirements. This is inclusive of completing an annual Mass Youth Soccer Adult Registration. This will initiate a Criminal Offender Records Information (CORI) and a National Criminal background check of which includes s State and National Sex Offender Search that will be processed on your behalf.

You are also required to self disclose any findings or criminal dispositions along with any information that may be visible to Mass Youth Soccer when conducting these background checks and searches using the text box below. If you do not have any information to disclose, place N/A in the box. *

Please upload a scanned or photo file of your government issued photo ID. *

I affirm that the information I have provided is true and accurate. I understand that if it is found that I have knowingly misrepresented any information, I will not be allowed to participate in any Mass Youth Soccer events.

Use the box below to provide your electronic signature. * 🛈

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