Insurance Forms

AYSO Regional Equipment Insurance Program

This coverage is for loss or damage to regional equipment due to fire, vandalism or other specified causes (subject to actual policy terms and conditions.) Note: this is a completely voluntary program for any region who wishes to participate and pay for this coverage directly from regional funds. Download the application for more information.

2009 Regional Equipment Insurance Program (application form)

Soccer Accident Insurance (SAI) Claim Form with instructions:

For Injuries occurring on and after July 1, 2009.

SAI Brochure 2009 (English)

SAI Brochure 2009 (Spanish)

SAI Claim Form with Instructions 2009 (English)

Soccer Accident Insurance (SAI) Claim forms w/Instructions:

For Injuries between July 1, 2007 and June 30, 2009.

The SAI carrier is Chubb and the third party administrator continues to be Health Special Risk, Inc. (HSR).

Note: this form, when completed, should be mailed to the address located at the top of the form by the claimant.

SAI Claim with Instructions - June 2008

SAI Brochure - rev 5-2008

SAI Claim with Instructions - June 2008 (Spanish)

SAI Brochure - rev 5-2008 (Spanish)

Incident Report Form:

(Accident report)

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.

Incident Report Form with Instructions

Participation Release Form

At the March, 2006 meeting, the National Board of Directors re-opened a discussion on the use of the Participation Release form. It was decided to continue use of the form. It was also decided that the signature of a parent should be sufficient and that it is no longer necessary to secure a signature of the treating physician. In an instance where a player is away from home at an event or competition and becomes injured, and a parent/guardian is not present, a facsimile with a parent/guardian signature is acceptable. The board revoked the option that the coach may sign on the parent/guardian's behalf. The form must bear the signature of a parent or guardian.

This form protects not only AYSO, but more importantly, the participants. Too often participants are out playing again before they are physically ready. Players should not participate until they are ready to play again. This form should also be used in cases of major illness.

Directions for use:

1. The Regional Safety Director should enter the mailing information located in the lower portion of the form on a master copy of the form each year, and prepare copies for distribution or make the form downloadable from the Region’s web site

2. One or several blank forms should be given to all team coaches as part of the materials provided them at the beginning of any season.

3. Tournament directors would be advised to have a supply on hand as well.

4. The form should eventually be sent to the Regional Safety Director for filing, but could be retained by the coach for a week or so in the event anyone might question the participation of the player subsequent to an illness or injury. (At the Region’s option a two part NCR version of the form could be produced so that the coach retains a copy and sends the original to the Regional Safety Director.)

5. The form is only required when it is known that the player has had to seek emergency room treatment or a physician office visit to treat an injury or illness affecting the player’s readiness to participate.

Participation Release Form

For General Liability Certificates (eCerts):

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AYSO eCerts User Guide

If you have insurance questions, please send a message to insuranceclaims@ayso.org