Player Loan Form

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Date	19.10.2016
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Player Loan Form

Form to loan a player between two US Club Soccer members
Directions:
1. Club #2 (club obtaining player) completes their portion of this form and sends it to Club #1 (club loaning player).
2. Club #1 completes their portion of this form, returns it to club #2, and gives a copy to the player, along with their current US Club Soccer player’s card.
3. Club #1 is responsible for sending a copy of this completed form to their US Club Soccer, Admin Staff Region Representative.
Note: It is NOT necessary to receive US Club Soccer’s approval of this loan as long as a copy of the loan form and a valid player card accompany the player to the competition; and a copy is sent to US Club Soccer.
Note: The player’s insurance coverage applies only if Club #1 submits a copy of the completed document to US Club Soccer in one of two ways:

Go to Contact Us at usclusoccer.org to find your state’s Admin Staff Region Representative

AdminRegionA@usclubsoccer.org; AdminRegionB@usclubsoccer.org; AdminRegionC@usclubsoccer.org; AdminRegionD@usclubsoccer.org; AdminRegionE@usclubsoccer.org;

Email a scanned version of completed / signed document PRIOR to the start of competition to your state’s Admin Staff Region Representative listed above OR
Mail with a postmark prior to the competition start date to address below - Attn: Player Loan.
Faxed forms are NOT acceptable.

Please print clearly Today’s date:

Player’s Name		Card Expiration Date
Player’s Identification Number (as shown on card)
Player’s Date of Birth	Jersey #

Date(s) for Loan of Player
Name / Location of Event
Date(s) of Event

Club #1 - Club Loaning Player State -
Team Name	Team Identification #
Club Rep. Signature	Club Fax #
Print Name	Position

Club #2 - Club Receiving Player
Team Name	Team Identification #
Club Rep. Signature	Club Fax #
Print Name	Position

Administrative Office: Attn: Player Loan 716 8^th Avenue North Myrtle Beach, SC 29577 (843) 429-0006
Form R007-Player Loan

4/2012

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