Forms

Parent Waiver

  • I certify that my child is in good physical condition and is physically and psychologically prepared to participate in this program. I hereby give my consent to Chesapeake United Soccer Club to provide my child, through staff of its choice, customary medical/athletic training attention, transportation, and emergency medical services as warranted in the course of my child’s participation. I am fully aware of, and appreciate the risks, including the risk of catastrophic injury, paralysis, and even death, as well as other damages and losses associated with my child's participation in this event. I further agree on behalf of myself, my child and my heirs and personal representatives that the CHESAPEAKE UNITED SOCCER CLUB, along with the coaches, volunteers, employees, agents, officers, and directors of this organization, shall not be liable for any injury, loss of life, or other loss or damage occurring as a result of my child's participation in the event.

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Financial Obligation Form

  • VYSA Policy Regarding Nonpayment of Club/Team Financial Obligations by Travel Players

  • 1. Transfer between Clubs or Teams during Seasonal Year

    It is the policy of VYSA that all travel players registered with VYSA are responsible for making payments required in writing by their clubs and/or teams. Accordingly, VYSA will not process a transfer of a player from one club/team to another during the seasonal year if that player is not current on his or her financial obligations, provided that (1) the financial obligation is set forth in writing and acknowledged by the player’s family, and (2) the obligation is for the current seasonal year. For purposes of this policy, any written financial obligation signed by the player’s family will be sufficient, including a financial obligation set forth in an electronic registration document and acknowledged electronically at the time of registration. This policy does not apply to a player who changes clubs or teams between seasonal years. In the event that a club or team objects to a transfer by a player during or between seasons due to failure to make required payments, the club or team must, within three business days of the transfer request, submit to the VYSA office the required form objecting to the transfer. VYSA will notify the family that the transfer is being held until payment is made. A club or team must notify VYSA immediately upon payment (within two business days) to release the transfer request. In the event that VYSA determines a club or team has placed a hold on a transfer in bad faith, the club or team may be sanctioned.
  • 2. Involuntary Release of Player for Failure to Meet Financial Obligations

    If a player fails to meet his or her financial obligations pursuant to a written obligation, a club or team may involuntarily release the player at any time during the seasonal year, provided that the team has followed the process as outlined in the VYSA Travel Team Registration Manual (5.27). I understand and I agree to abide by the guidelines as stated in full.
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Medical Release

  • CUSC Player Medical Form

    This form must be completed by player’s parent/guardian and maintained by Coach/Team Manager for Soccer Season.
  • Player Information

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  • Parent/Guardian Contact Information

  • Emergency Contact Information

  • Player's Medical Information

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  • Medical Treatment Authorization

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  • As the parent/legal guardian of this player I hereby give my consent and permission for the player named below to be medically and/or surgically treated for injuries and/or illness of any kind or seriousness under the direction of Team Officials with a valid USYS Member Pass, until such time as I can be contacted. Further, I give my consent and permission to the physician and/or hospital and/or other health care provider selected to provide medical or surgical treatment, including, without limitation, dental care, hospitalization, injection, anesthesia, invasive surgery or any other form or kind of medical or surgical care (emergency or otherwise) for the player.

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VYSA KidSafe Form

  • KidSafe Disclosure Statement and Release Form

    Kidsafe is a risk management program designed to foster safe circumstances for every person, and especially every child, who participates in a US Youth Soccer affiliated activity. It is a program to inform all VYSA personnel and VYSA members concerning the risks associated with our youth soccer programs. This form will be kept in absolute confidentiality by VYSA or each of its respective members and will be updated annually.
  • Personal Information

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  • Disclosure Statement

    Please select “YES” or “NO” to the following questions
  • Release

    I understand that my position with VYSA or any of its members is contingent upon my truthful completion and VYSA’s or any of its members’ review of this form. I authorize and understand that VYSA or any of its members will conduct a background check and may obtain a background report and that I may be requested to provide a set of fingerprints. I understand that I may be immediately discharged for any misrepresentation or material omission on this form. I understand that pending arrest or closed arrest is not an automatic bar to consideration of my application, but it is the intent of VYSA or any of its members to deny a position to any person who has been convicted of an offense that VYSA or a VYSA member determines disqualifies that person from providing services to VYSA or a VYSA member. I understand that VYSA or any of its members will take into account the nature of the offense, the date of the offense and the relationship between the offense and the position for which I am applying and any mitigating factors.
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Interstate Permission Form

  • Rule 201 of the US Youth Soccer Policy on Players and Playing Rules

    Requires that a youth player register each seasonal year in the State Association in which he/she resides with his/her parent(s)/guardian(s) or with the State Association in which the player is attending a boarding school or college or university the player is attending. A youth player wishing to participate with a team of a State Association other than the State Association in where the player is registered must first register with the State Association in which the player resides or is attending school and then receive written permission from both State Associations prior to participation. This Interstate Permission Form may be used by (1) a player requesting permission to play as a member of a team of a State Association (the “Accepting State Association”) other than the State Association (the “Releasing State Association”) in which the player is registered, (2) a player requesting permission to play on a team in another State Association as a guest player, or (3) a player is relocating: moving from one State Association to another State Association during the seasonal year. It is the responsibility of the player and parent or guardian to provide the form to the appropriate parties within both the releasing and accepting State Associations.
  • Note that some State Associations have entered into agreements providing automatic permission to play on a team in another State Association. Some State Associations prohibit the use of guest players, so always check with the State Association with which the player is registered to determine whether the use of this form is needed.

    Instructions: 1. Player must register and pay any appropriate fee(s) of the State Associations in which the player resides. 2. Complete the Player Information section of the Interstate Form or a form provided by the State Association. 3. Send the completed Interstate Form to the appropriate party within the State Association in which the player is registered. 4. Releasing State Association must complete the Releasing section of this Form. 5. Acceptation State Association must complete the Accepted section of this form.
  • Player Information

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  • Type of Change

    Please indicate the type of permission you are essaying and State Associations involved: 1. Interstate Permission, 2. Guest Player
  • 1. Interstate Permission

    Player is registered with one State Association but wishes to play as a member of a team of another State Association
  • 2. Guest Player Permissions

    Player is seeking to guest play with team from another State Association
  • 3. Relocation Release

    Player has moved from one State Association to another State Association during the seasonal year.

 

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