Financial Assistance Form
Mansfield Youth Soccer provides financial assistance to those families in need. Financial Assistance is completely confidential.

Please note: Mansfield Youth Soccer cannot give financial assistance on uniforms. However is a uniform is needed a used one may be available.
Family Name *
Your answer
Address *
Your answer
City, State, Zip *
Your answer
Phone Number *
Your answer
Email Address
Your answer
Number of Players Needing Assistance *
Player Name Needing Assitance *
Please list each child's name and Date of Birth
Your answer
Amount of assistance being requested *
Intown U5-U14 fees $105 ~ Travel fees $115
Have you applied for financial assistance in the past *
What area would you be able to volunteer *
For Your Information
Mansfield Youth Soccer is committed to protecting the privacy of your personal information. This
privacy statement applies to all financial assistance applicants and their families. Mansfield Youth soccer
does not share or disclose any of the information included in this form. Only the Registrar, Treasurer,
President and Vice President are privy to this information.
Parent/Guardian's Authorization to Participate and Consent for Medical Treatment
I, the parent/guardian of the registrant, a minor, agree that the registrant and I will abide by the rules of the USYSA, its affiliated
organizations and sponsors. Recognizing the possibility of physical injury associated with soccer and in consideration of the USYSA
accepting the registrant for its soccer programs and activities (the”Programs”), I hereby release, discharge and/or otherwise indemnify
the USYSA, its affiliated organizations and sponsors, their employees and associated personnel, including the owners of fields and
facilities utilized for the Programs, against any claim by or on the behalf of the registrant as a result of the registrant’s participation in
the Programs and/or being transported to or from the same, which transportation I hereby authorize.

As Parent or Legal Guardian of the above-named player, I further hereby give my consent for emergency medical care prescribed by a
duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions are necessary to preserve
life, limb, or well being of my dependent. My signature below signifies my agreement to abide by the aforementioned statements
regarding the registrant’s participation in USYSA soccer programs:
Parent "Signature" *
Your answer
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