Missouri Permission to Participate Form This form must be

Missouri Permission to Participate Form
This form must be completed and signed by all parties for acknowledgement & authorization of a youth
player to participate in an event outside of their own club prior to the tryout period.
Both clubs are responsible for securing and retaining a copy of this document. Any misrepresentation made
on this document can result in player suspensions of up to one year.
Kick Around/Practice
Guest Play Tournament
Tourney Name: ____________________ Event Name: ____________
Name of Player: ___________________________ DOB: _______ ID# ________________
Current Club: ________________________________________ Age/Gender: ________
Primary Rostering Team of Player: ________________________________
Primary Coach Name: ____________________________ Phone: _____________________
Club Seeking Permission for Contact: __________________________________________
Club Coach or Admin Name requesting: _______________________________________
Phone: ___________________ Dates of Contact: ________________________________
By signing below I verify that all information above is true and accurate and acknowledge that the player has permission to participate
in activities associate with another club. I understand that this permission does not grant or authorize a player transfer or rostering.
Primary Coach Signature: __________________________________________ Date: ____________
Primary Club Registar Signature: ____________________________________ Date: ____________
Signature of Person Requesting Contact: _________________________ Title: _________________