Request for Certificate of Insurance
Provided by Missouri Youth Soccer Association
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Email *
Name of Person requesting *
Please select what type of member you are: *
Club / League or member team name *
Name of Facility to be covered in COI *
Full address of Facility to be covered in COI *
Special Instructions:
I understand that COI's do not cover a private residence or property not designed for soccer *
I understand that this does not provide teams with coverage for indoor leagues with "walls" (i.e. dasher boards as found on indoor soccer fields) unless approved after inspection. *
I understand that by extending insurance coverage over an indoor space that MYSA does NOT provide coverage or assume any liability for any transmission of COVID-19 or other socially transmitted disease. Every entity that requests coverage must create and implement of mitigation plan that is within the guidance of their local health authorities. *
I affirm that all players participating are registered with Missouri Youth Soccer Association *
I affirm that I am in possesion of a fully executed USYS Medical Waiver for each participant *
Your e-mail for Certificate to be sent to: *
Contact Phone Number: *
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