Kansas Youth Soccer
Disclosure Statement For Certification


The information that you provide on this disclosure is stored on a secure server and will only be visible to the Risk Management staff at Kansas Youth Soccer.

Please fill out the form below and press Submit.
 
 
 
 
 
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(Check "Do not have Drivers License" checkbox if you do not have one)

 
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Please Answer Yes or No to the following question(s):
Answering YES to any of the below inquiries will not necessarily disqualify you from participation with the Kansas Youth Soccer or its members, but will require the Kansas Youth Soccer to make further inquiries before you will be permitted to begin your activities on their behalf.

  Yes     No 
  Yes     No 
  Yes     No 
  Yes     No 
  Yes     No 

I hereby grant to Kansas Youth Soccer and its member organizations, the authority to obtain my criminal and driving record, if any. I understand that I agree to inform the above, if any any of this information changes. I also agree to be fingerprinted and photographed if necessary to confirm my identity and criminal history. I affirm under the penalties for perjury that the forgoing is true and accurate.

By completing and submitting this disclosure statement electronically via the Internet, I agree to its terms and conditions and my signature thereto may be implied.

Signature


 
 

Questions?