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AYSO REGION 769 - WEST OAHU

Region Forms & Documents

Parents Meeting MY2019

Important facts you need to know about West Oahu and AYSO.

6U/8U Parent Meeting slides
10U Parent Meeting slides
12U Parent Meeting slides

Kid Zone Pledge Form

Coaches Handbook – COMING SOON!!

Player Evaluation Form

Player Evaluation forms should be completed by the coach by the end of the season.  These evaluation forms are used to assist Age Group Coordinators to balance teams.

Incident Report Form

The AYSO Incident Report Form is used whenever there is a personal injury, damaged property, or threats of or actual physical violence surrounding an AYSO game, practice, event or property. The form should be prepared by the Coach, AYSO Official, or other AYSO Volunteer. The form may also be prepared by a member of the regional staff such as the regional safety director, or by tournament or event staff members.

Participation Release Form

Whenever a player or youth volunteer has suffered a concussion or an injury or illness that required the care of a physician or a visit to an emergency care facility, the AYSO Participation Release Form must be given to the parents or guardians. The participation release form must be completed in full and signed by the child’s parents or guardians before the player or youth volunteer will be allowed to participate further in the program.

Player Release Form

Once the team coach has assumed charge of the children on his/her team, the coach remains responsible until a duly designated adult has taken charge of each child after a practice or game.  No child shall be left unsupervised after a game or practice.  Parents who are unreasonably late or consistently tardy may be reported to the Regional Child and Volunteer Protection Advocate (CVPA) for action. Each coach may establish a standing policy of where children may be picked up by late parents.  AYSO does not encourage children to walk or ride a bicycle home or to a friend or relative’s house. However, we recognize that it may be necessary in some cases.  Neither AYSO nor the coach can be responsible for a child’s safety if they do walk or ride home. A parent or guardian assumes full responsibility for the safety of the child once he or she is released from a practice or game. Please note that this also applies in the case of players who are of legal driving age and transport themselves to and from AYSO activities.  If your child will be walking, riding a bicycle or driving themselves home from practice or games, please complete the following information in order for your coach to release them.

Soccer Accident Insurance (SAI) Brochure

AYSO purchases Soccer Accident Insurance ("SAI"), which pays excess medical costs up to $50,000 maximum per accident to an insured person for accidental bodily injuries incurred as a direct result of participation in a covered activity subject to the policy terms, conditions and exclusions.Eligibility for benefits is 52 weeks from the policy effective date or the date of a covered accident. Download the SAI Brochure for more detailed explanation of the plan. Accident Medical Expense Benefits are only payable:

  • for usual and customary charges incurred after the deductible has been met;
  • for those medically necessary covered expenses that the covered person receives;
  • first medical or dental expense must be incurred within 90 days of covered accident;
  • proof of loss must be filed within 90 days;
  • each claim is subject to a $1000 Deductible; and 20% member Coinsurance;
  • Claims will require:
    • Copies of primary Explanation of Benefits (EOB)
    • Copies of itemized insurance billing forms - UB04 or CMS1500
  • No Primary Insurance: If there is no other insurance available to the registered member, the medical benefit will be processed on a primary basis subject to Usual and Customary rates, and the policy terms, conditions and exclusions.

  • MAXIMUM BENEFITS PAYABLE: (subject to policy terms, conditions & limits)
    • $50,000 maximum excess medical costs
    • $15,000 for Accidental Death & Dismemberment
    • $10,000 for Dental Benefit for injuries to sound natural teeth
    • $10,000 for Orthopedic Benefit
    • $1,000 Physical Therapy; $100 per day up to 10 days

All AYSO currently registered* members (players, coaches, managers, team workers, referees, officials and volunteer workers) are "Covered Persons" for accidental bodily injury while participating in the following covered activities:

  • Team practice sessions, scheduled games, tournaments, or other sponsored activities (meetings, banquets, fundraisers) provided they are under the direct supervision of an AYSO registered volunteer.
  • Travel of covered members to and from a sponsored activity such as practice sessions, games, tournaments, or AYSO sanctioned activities, provided that players are traveling as a team and a licensed adult driver operates the vehicle.

Concussion Information

AYSO has partnered with the Center for Disease Control (CDC) to use the “Heads Up” Concussion training tools in support of the following guidelines in order to ensure the safety of all our participants:

The AYSO/CDC Parent/Athlete Concussion Information Sheet should be used to inform parents and players about the potential risks associated with concussions. When required by state law, signatures of a parent and/or athlete must be obtained each membership year. See State Law Matrix for details

AYSO CDC Concussion Handout

CDC Heads Up Concussion training is strongly recommended for all coaches, referees, executive members, Advisory Commission members, Section/Area/Region board and staff members. This training will be required for coaches and other “officials” as required by state law. Go to www.aysotraining.org

The AYSO/CDC Coach/Referee Action Plan provides coaches/referees with the signs and symptoms of concussion and the recommended steps to take whenever a player exhibits any sign or symptom.

AYSO requires the new AYSO Participation Release Form, signed by a parent/guardian, acknowledging that the player has been given clearance before the player can return to play.

AYSO strongly recommends that parents/guardians seek medical attention whenever a player exhibits any signs or symptoms of a concussion and obtain a clearance by a medical professional before the player is allowed to return to play. When required by state law, parents must obtain a medical clearance in addition to completing the Participation Release Form.

If a player exhibits any signs or symptoms of a concussion and is removed from play or not permitted to participate, the player may not return to play for the remainder of that day.

The Region Safety Director must receive an AYSO Incident Report, signed Participation Release, copy of the signed Player Registration Form and copy of any SAI claim whenever a player is removed from play due to signs/symptoms of concussion. Fax/email forms to [email protected].

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AYSO REGION 769 - WEST OAHU

94-104 Kolea Place 
Waipahu, Hawaii 96797

Email Us: [email protected]
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