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Alabama Soccer Association Annual Organization Affiliation Form

Fall ( ) Spring ( ) Year ( ) Current # of players

ORGANIZATION:

ORGANIZATION WEBSITE: (To be put as a link on the ASA website)

FACEBOOK AND/OR TWITTER: ______________________________________________________________________

ORGANIZATION CONTACT: TITLE:

ADDRESS:

CITY: STATE: ZIP:

PHONE: ( ) (H); ( ) (W); ( ) (C) Area Code Area Code Area Code

FAX: ( ) EMAIL ADDRESS: Area Code

REGISTRAR NAME: PLEASE PRINT

REGISTRAR STREET ADDRESS:

CITY: STATE: ZIP:

REGISTRAR PHONE: ( ) (H); ( ) (W); ( ) (C) Area Code Area Code Area Code

FAX: ( ) EMAIL ADDRESS: Area Code

THESE ITEMS MUST BE INCLUDED AND COMPLETE

Current listing of organization officers INCLUDING their address, phone numbers & email address Registrar, President, Treasurer and Director of Coaching MUST be entered by the club Registrar in the

Security section in Stack Sports Risk Management Training Requirements signed and returned Risk Management Procedure and Protocol Acceptance Letter signed and returned ______Agreement to have all Adults who have access to children or players under 18 will have a background

check done every year. It is recommended to have all Board Members and Adults in your program. Current copy of organization’s constitution, bylaws, operational rules (if updated since last year or new

member of ASA). $110.00 Annual Affiliation Fee – “New or Returning” (DUE by JULY 1st each year). You are agreeing the affiliation fee will be paid in Stack Sports when your organization is created online.

By submitting this Organization Affiliation Form and agreement of affiliation fees, our organization agrees to abide by all Rules and Regulations of ASA.

(Signature) Title Date

Alabama Soccer Association Annual Organization Affiliation Form

In accordance with the United States Soccer Federation (USSF) Rule 212 all players of a club or league must be registered with one of the federation’s organization members.

As an affiliate of Alabama Soccer Association (ASA) I agree to abide by this rule by registering all of our players with ASA and/or another organization member of USSF.

At the request of ASA we are willing to provide proof we have met the requirements of USSF Rule 212.

Currently our club has players in the following Divisions. Please check all that apply or explain why you will not have that division (i.e. club will not have any players in that division) or if the players in that division will be registered with another USSF member, please note where they will be registered (i.e. US Club, AYSO, etc).

Division I □

Division II □

Division III □

Division IV □

Adults □

We commit that players in the above specified divisions will be registered in Stack Sports and put on teams in a timely manner.

We also understand that any Division IV players not registered in the Stack Sports registration system will not be covered through ASA insurance.

NAME OF CLUB/LEAGUE:

PRESIDENT: (Print Name) (Signature)

WITNESS:

(Print Name) (Signature)

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Risk Management Training Requirements

Date Season

Club

This confirms that every coach/team manager in my club has or will take the following certification courses year and attach them to the Stack Sports required page plus the club will keep record of all of their adult members who have direct contact with children under 18 to make sure everyone is up to date with the guidelines. The following is required for each adult working with children under 18 and has direct contact to the players on a regular basis: __________ Concussion Awareness Training __________ Alabama Sport Safety Act -https://www.coachsafely.org/ __________ SafeSport Training

__________ Review and Implement US Soccer Bylaw 212 and Policy 212-3 including Limiting One-on-One Interactions to your club policies

Club Registrar

Signature

Risk Management Procedures and Protocols Acceptance Letter

CLUB

We President and ______________________________ Executive Director of ___________________________(club)

Acknowledge and confirm receipt and understand the Concussion Procedure and Protocol policy from Alabama Soccer Association & US Youth Soccer. Our organization agrees to follow the guidelines as set forth in these documents. All coaches within our organization have received and will abide by this procedure. Acknowledge and confirm receipt and understand US Soccer’s Safe Soccer Framework, Bylaw 212, and Policy 212-3 from Alabama Soccer Association and US Soccer. Our organization agrees to follow the guidelines as set forth in these documents. All coaches within our organization have received and will abide by these procedures. All notification forms are on file with our club registrar and uploaded in Stack Sports as required for adult members (coaches, managers, trainers, etc.) DATE

President (SIGNATURE)

Executive Director

(SIGNATURE)

Club Organization

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Background Through Stack Sports Confirmation

Date Season

Club

This confirms that every Adult working with children (players under 18) or have direct access to children in my club has or will do a background check through Stack Sports and my club has a copy on file.

Club Registrar

Signature

SUBMIT TO: Alabama Soccer Association

4678 Valleydale Road, Suite 200 Birmingham, AL 35242 Phone: (205) 991-9779

Fax Number: (205) 991-3736

OR EMAIL STAFF MEMBER: Lynn Bertovic lynn@alsoccer.org Jennifer Pfeiffer Jennifer@alsoccer.org

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