------------------------ SD State Soccer Notification of Travel Form

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Coach First and Last Name:

Coach Address (Street, City, State Zip all on one line):

Coach Cell Phone:

Enter a valid phone number. Example: 123-456-7890

Coach eMail:

Enter a valid email address. Example: name@company.com

Club and Team Name (must have both!):

Team ID (Found on Roster):

Age Group:

Gender:

Boys

Girls

Type of Event:

Event Name with City and State:

Dates of Event:

Rules and Regulations:
1. I state that the information provided on this form is accurate during the dates listed. If this is Sanctioned travel, I have so advised my team. If this is NOT sanctioned travel, I CERTIFY THAT I HAVE ADVISED ALL PARTICIPANTS' PARENTS THAT THEIR PLAYERS ARE TRAVELING WITHOUT STATE ASSOCIATION INSURANCE OR ASSISTANCE. I agree to indemnify the State Association for any and all losses or damages caused by my misrepresentation of this notification.

2. This team is properly registered by the rules of US Youth Soccer, South Dakota State Soccer Association, and the club listed.
3. Any individual found entering false information will be subject to penalties/sanctions by South Dakota State Soccer Association.

Team Representative:__________________________ Date:___________________