YOUTH Player Insurance
What to do when an injury occurs:
- Fill out and mail/fax/email the Accident Medical Claim Form to the state office within 30 days of the injury. Please provide the referee report (long form) if possible.
- The state office will verify that you are a registered player participating in a sanctioned event. Players electing to participate in non-sanctioned events are not covered by this policy.
- If approved the state office will send the claim form to the insurance company for processing.
- The injured player is then responsible for providing the insurance company with bills and requested information. The state office does not handle any bills or payments.
Arkansas Soccer Association's insurance provider is AMSIS.
DO NOT SEND FORM TO INSURANCE COMPANY - IT WILL ONLY DELAY YOUR CLAIM.
Explanation of coverage
Email form to: Jim Walker
Mail: ASA, 9871 Brockington Road, Suite 10, Sherwood, AR 72120
ADULT Player Insurance
What to do when an injury occurs:
- Fill out and mail/fax/email the Special Risk Accident Claim Form (below) to the state office within 30 days of the injury along with the referee report (long form) if possible.
- The state office will verify that you are a registered player participating in a sanctioned event. Players electing to participate in non-sanctioned events are not covered by this policy.
- The state office will send the insurance forms to the national office for approval. If approved, the national office will forward the claim to the insurance provider.
Explanation of Insurance - English and Spanish
Special Risk Accident Claim Form - English
Special Risk Accident Claim Form - Spanish
Release of Liability Agreement
Click Here to Visit USASA's Website for More Information and Forms
DO NOT SEND FORM DIRECTLY TO THE INSURANCE COMPANY. THIS WILL ONLY DELAY YOUR CLAIM.
Email form to: Jim Walker
Mail: ASA, 9871 Brockington Road, Suite 10, Sherwood, AR 72120
CERTIFICATES OF INSURANCE
Clubs can request Certificates of Insurance Here