KPSL TEAM ROSTER REGISTRATION FORM

KPSL TEAM ROSTER REGISTRATION FORM

2022 - 2023 SOCCER YEAR
CLUB:*
TEAM NAME:*
COACH:*
TEAM MANAGER:
AGE GROUP:*
GENDER:*
CONTACT NAME:*

First NameLast Name
CONTACT PHONE:*
Please enter a valid phone number.
CONTACT EMAIL:*
example@example.com
Do you need your roster & player cards prior to the start of Heartland League?*

YesNo
If yes, by what date do you need your documents?

MonthDayYear
Administrative team fee:
Per team fee paid with the initial request for team passes
and is good for the seasonal year Fall 2020 - Spring 2021 only.
Team Level:
Team Administrative Fee:
7v7 = $40 9v9 = $55 11v1 = $70
Admin Fee
Player / Coach Passes:
No player passes or rosters can be issued without payment. No coaches / administrator cards can be issued without prior approved background check completion.
KANSAS COACH'S RISK MANAGEMENT POLICY & SAFESPORT

PLEASE NOTE:

Risk Management Background checks are done through KSYSA & GotSoccer, not KPSL.

https://www.kansasyouthsoccer.org/coaching/safesoccer/

U.S. Center for SafeSport

On February 14, 2018, (S.534) was signed into federal law. Click Here for the U.S. Center for SafesSport's fact sheet and about the legislation.

Online awareness/prevention training is available and consists of three (3) training modules which include:

Sexual Misconduct Awareness and Education
Mandatory Reporting
Emotional and Physical Misconduct

GENERAL INFO

All KSYSA Coaches (18 years or older) working with youth games and children for clubs registered in Kansas must login or register online with GotSoccer each seasonal year to check to make sure they will have an approved background check and SafeSport Certification completed for the upcoming season.

Protecting Young Victims from Sexual Abuse and Safe Sport Authorization Act of 2017 imposes a duty to report suspected child abuse, including sexual abuse, within 24 hours to the appropriate authorities. An individual who is required, but fails, to report is subject to criminal penalties.

ALL Club Staff Members, including Team Managers, need to complete this requirement but those who wish to be listed on an official state rosters must have a completed background screening check & SafeSport Certification and have been approved before being added to a state roster or receiving a US Youth Soccer Member Pass Card from the clubs registrar. If you do not complete the background screening check or SafeSport Certification, you will NOT be considered for approval as a KSYSA Coach/Staff working youth games. The information that you provide to GotSoccer Registration and Risk Management is stored on a secure server and will only be visible to the Risk Management Staff at Kansas Youth Soccer.

HOW TO COMPLETE YOUR BACKGROUND CHECK & SAFESPORT

The cost for background checks is $20 bi-annually. (September 1 to August 31).
Please contact your club first to see if they have a voucher code that would waive this fee for you.

The SafeSport Training Courses is FREE of charge if you follow the instructions below. It is an ANNUAL renewal for you to complete! You should NEVER have to pay for SafeSport so if it ask for you to do so then you are doing it incorrectly.

RETURNING CLUB COACHES & STAFF:
If you have previously completed a background check in GotSoccer, you already have a username and password - please use that information to submit any new information/background checks.

If you have previously completed SafeSport Certification directly through SafeSports website then all you need to do is make sure the SafeSport account and your GotSoccer have the EXACT same First Name, Last Name and Email and then follow the SafeSport Instructions listed below to complete requirement.

If you do not know your GotSoccer or SafeSport information the system will resend it to you via the email the account was under. If you no longer use that email address then contact your club to have them update your GotSoccer account or contact SafeSport for assistance.

Other questions email KSYSA at info@kansasyouthsoccer.org.

NEW CLUB COACHES AND STAFF:

If you are new to Kansas Youth Soccer, you need to contact your club for them to create your Kansas Got Soccer Account. If you are switching clubs within KSYSA please email Carrie Douglas at cdouglas@kansasyouthsoccer.org so he can switch your Got Soccer account over to your new club. You DO NOT need to make a new GotSoccer Coaching or Manager account.
PLAYER ROSTER
PLAYER #1:
Player #1 Name:

Last NameFirst Name
Player #1 Birth Date:

MonthDayYear
Date
Player #1 Jersey #:
#s:0/00 - 99
Player #1 Primary/Secondary:
Plyr 1 Pmy
Plyr 1 Sec
Prmy
Scndy
PLAYER #2:
Player #2 Name:

Last NameFirst Name
Player #2 Birth Date:

MonthDayYear
Date
Player #2 Jersey #:
#s:0/00 - 99
Player #2 Primary/Secondary:
Plyr 2 Pmy
Plyr 2 Sec
Prmy
Scndy
PLAYER #3:
Player #3 Name:

Last NameFirst Name
Player #3 Birth Date:

MonthDayYear
Date
Player #3 Jersey #:
#s:0/00 - 99
Player #3 Primary/Secondary:
Plyr 3 Pmy
Plyr 3 Sec
Prmy
Scndy
PLAYER #4:
Player #4 Name:

Last NameFirst Name
Player #4 Birth Date:

MonthDayYear
Date
Player #4 Jersey #:
#s:0/00 - 99
Player #4 Primary/Secondary:
Plyr 4 Pmy
Plyr 4 Sec
Prmy
Scndy
PLAYER #5:
Player #5 Name:

Last NameFirst Name
Player #5 Birth Date:

MonthDayYear
Date
Player #5 Jersey #:
#s:0/00 - 99
Player #5 Primary/Secondary:
Plyr 5 Pmy
Plyr 5 Sec
Prmy
Scndy
PLAYER #6:
Player #6 Name:

Last NameFirst Name
Player #6 Birth Date:

MonthDayYear
Date
Player #6 Jersey #:
#s:0/00 - 99
Player #6 Primary/Secondary:
Plyr 6 Pmy
Plyr 6 Sec
Prmy
Scndy
PLAYER #7:
Player #7 Name:

Last NameFirst Name
Player #7 Birth Date:

MonthDayYear
Date
Player #7 Jersey #:
#s:0/00 - 99
Player #7 Primary/Secondary:
Plyr 7 Pmy
Plyr 7 Sec
Prmy
Scndy
PLAYER #8:
Player #8 Name:

Last NameFirst Name
Player #8 Birth Date:

MonthDayYear
Date
Player #8 Jersey #:
#s:0/00 - 99
Player #8 Primary/Secondary:
Plyr 8 Pmy
Plyr 8 Sec
Prmy
Scndy
PLAYER #9:
Player #9 Name:

Last NameFirst Name
Player #9 Birth Date:

MonthDayYear
Date
Player #9 Jersey #:
#s:0/00 - 99
Player #9 Primary/Secondary:
Plyr 9 Pmy
Plyr 9 Sec
Prmy
Scndy
PLAYER #10:
Player #10 Name:

Last NameFirst Name
Player #10 Birth Date:

MonthDayYear
Date
Player #10 Jersey #:
#s:0/00 - 99
Player #10 Primary/Secondary:
Plyr 10 Pmy
Plyr 10 Sec
Prmy
Scndy
PLAYER #11:
Player #11 Name:

Last NameFirst Name
Player #11 Birth Date:

MonthDayYear
Date
Player #11 Jersey #:
#s:0/00 - 99
Player #11 Primary/Secondary:
Plyr 11 Pmy
Plyr 11 Sec
Prmy
Scndy
PLAYER #12:
Player #12 Name:

Last NameFirst Name
Player #12 Birth Date:

MonthDayYear
Date
Player #12 Jersey #:
#s:0/00 - 99
Player #12 Primary/Secondary:
Plyr 12 Pmy
Plyr 12 Sec
Prmy
Scndy
PLAYER #13:
Player #13 Name:

Last NameFirst Name
Player #13 Birth Date:

MonthDayYear
Date
Player #13 Jersey #:
#s:0/00 - 99
Player #13 Primary/Secondary:
Plyr 13 Pmy
Plyr 13 Sec
Prmy
Scndy
PLAYER #14:
Player #14 Name:

Last NameFirst Name
Player #14 Birth Date:

MonthDayYear
Date
Player #14 Jersey #:
#s:0/00 - 99
Player #14 Primary/Secondary:
Plyr 14 Pmy
Plyr 14 Sec
Prmy
Scndy
PLAYER #15:
Player #15 Name:

Last NameFirst Name
Player #15 Birth Date:

MonthDayYear
Date
Player #15 Jersey #:
#s:0/00 - 99
Player #15 Primary/Secondary:
Plyr 15 Pmy
Plyr 15 Sec
Prmy
Scndy
PLAYER #16:
Player #16 Name:

Last NameFirst Name
Player #16 Birth Date:

MonthDayYear
Date
Player #16 Jersey #:
#s:0/00 - 99
Player #16 Primary/Secondary:
Plyr 16 Pmy
Plyr 16 Sec
Prmy
Scndy
PLAYER #17:
Player #17 Name:

Last NameFirst Name
Player #17 Birth Date:

MonthDayYear
Date
Player #17 Jersey #:
#s:0/00 - 99
Player #17 Primary/Secondary:
Plyr 17 Pmy
Plyr 17 Sec
Prmy
Scndy
PLAYER #18:
Player #18 Name:

Last NameFirst Name
Player #18 Birth Date:

MonthDayYear
Date
Player #18 Jersey #:
#s:0/00 - 99
Player #18 Primary/Secondary:
Plyr 18 Pmy
Plyr 18 Sec
Prmy
Scndy
PLAYER #19:
Player #19 Name:

Last NameFirst Name
Player #19 Birth Date:

MonthDayYear
Date
Player #19 Jersey #:
#s:0/00 - 99
Player #19 Primary/Secondary:
Plyr 19 Pmy
Plyr 19 Sec
Prmy
Scndy
PLAYER #20:
Player #20 Name:

Last NameFirst Name
Player #20 Birth Date:

MonthDayYear
Date
Player #20 Jersey #:
#s:0/00 - 99
Player #20 Primary/Secondary:
Plyr 20 Pmy
Plyr 20 Sec
Prmy
Scndy
PLAYER #21:
Player #21 Name:

Last NameFirst Name
Player #21 Birth Date:

MonthDayYear
Date
Player #21 Jersey #:
#s:0/00 - 99
Player #21 Primary/Secondary:
Plyr 21 Pmy
Plyr 21 Sec
Prmy
Scndy
PLAYER #22:
Player #22 Name:

Last NameFirst Name
Player #22 Birth Date:

MonthDayYear
Date
Player #22 Jersey #:
#s:0/00 - 99
Player #22 Primary/Secondary:
Plyr 22 Pmy
Plyr 22 Sec
Prmy
Scndy
# of Primary Players:
Total Primary Player Passes:
# of Secondary Players:
Total Secondary/Transfer Passes:
COACHES/MANAGERS ROSTER
COACH / MANAGER #1:
Coach/Manager #1 Name:

Last NameFirst Name
Coach/Manager #1 Birth Date:

MonthDayYear
Coach / Manager #1:
Coach#1 Value
Coach #1
COACH / MANAGER #2:
Coach/Manager #2 Name:

Last NameFirst Name
Coach/Manager #2 Birth Date:

MonthDayYear
Coach / Manager #2:
Coach#2 Value
Coach #2
COACH / MANAGER #3:
Coach/Manager #3 Name:

Last NameFirst Name
Coach/Manager #3 Birth Date:

MonthDayYear
Coach / Manager #3:
Coach#3 Value
Coach #3
COACH / MANAGER #4:
Coach/Manager #4 Name:

Last NameFirst Name
Coach/Manager #4 Birth Date:

MonthDayYear
Coach / Manager #4:
Coach#4 Value
Coach #4
COACH / MANAGER #5:
Coach/Manager #5 Name:

Last NameFirst Name
Coach/Manager #5 Birth Date:

MonthDayYear
Coach / Manager #5:
Coach#5 Value
Coach #5
# of Coach/Mgr Passes:
Total Coach/Mgr Passes:
TOTAL DUE:
Administrative Fee + Player Passes + Coach/Mgr Passes

Credit Card Payment - All Fields Required

USD

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Upload Player Birth Certificates for verification here:*

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Upload Player Medical Releases here:*

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Upload Player Pictures here: *file must be jpeg format *each file MUST BE TITLED with the player's FIRST & LAST NAME*

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COMMENTS:
KPSL Registrar: Sheila Ozburn
Email: registrar@kpsl.org
KPSL Address: 10529 South Warwick St.
Olathe, KS 66061
Should be Empty: