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Content
Town/Club:
Date:
Team Name:
League:
Age:
Girls:
Team ID#:
Coach:
Address:
Ass’t Coach:
Address:
Shirt
#
Original:
Boys:
Div:
Change:
Shirt Color:
Section:
Phone:
City/State/Zip:
Phone:
City/State/Zip:
Last Name
First Name
Birth Date
Town
Phone
1
2
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5
6
7
8
9
10
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12
13
14
15
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18
19
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22
Transfers:
1
2
3
4
5
Mass Youth Soccer Roster Verification:_______________________________ Date:
______________
(If Applicable)
Coach Certification
Club/Town Certification
I Certify that I will comply with Mass Youth Soccer
and Leagues bylaws, playing rules, & Coach’s Code
of Conduct, and know the penalties for noncompliance.
All players and all coaches/managers meet all Mass Youth Soccer &
League requirements for affiliation and playing age, and the
town/club is properly affiliated.
Signature:______________________________________________
Coach’s Signature
________________________________
Referee:
Opposing Team:
Sched. Date:
Winner:
Actual Date:
Score: