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Insurance Forms & Information
Member Clubs are covered by insurance policies as part of their member benefits. Clubs receive secondary medical coverage for players and coaches as well as liability coverage for property owners; Directors and Officers Insurance for not for profit club boards and liability insurance for the coaches. More information on the insurance coverage can be found below.
Insurance Forms – Youth Soccer
- Membership Letter from Executive Director – October 25, 2019
- Membership Letter from Executive Director – October 25 2019
Indiana Soccer has recently (Sept.1, 2021) changed insurance companies to continue to provide our members with the best coverage at the most reasonable rates. More information from the new carrier (Players Health) will be added to this website as the documents become available. To learn more about the youth soccer general liability benefits and accident medical expense benefits & accidental death and dismemberment benefits, please click on the links below:
If you need to file a claim for an injury that happened AFTER to September 1, 2021, please use the links and forms below.
The new process is an online form. This saves time and provides you a better link to the claim process. Simply click the link below to begin filing your claim:
- 2022-2023 Indiana Soccer Youth or Youth Coach/Manager Medical Claim Form (Updated September 2022)
Insurance Forms – Adult Soccer
To learn more about adult soccer insurance forms including medical coverages, liability insurance summary, directors & officers liability, directors & officers insurance forms, optical coverages, adult medical claim form, please click on the links below:
- Release of Liability Agreement (Updated 3/22/2022) Must be completed each season per player, may be located on the registration form.
- Release of Liability Agreement – Spanish (Updated 3/22/2022)Must be completed each season per player, may be located on the registration form.
- USASA Medical Coverage Summary (Reviewed 3/22/2022)
- USASA Directors and Officers Liability Summary (Reviewed 3/22/2022)
- D&O List for Insurance Coverage (Updated 3/1/2022 – must be completed each year by each league)
- $25K Insurance Coverage Request Form (Updated 3/22/2022)
- Indiana Soccer ADULT Medical Claim Form (Updated 3/22/2022)
- Indiana Soccer ADULT Medical Claim Form-Spanish (Updated 3/22/2022)
- Insurance Claim Instructions (Reviewed 3/22/2022)
- Insurance Claim Instructions-Spanish (Reviewed 3/22/2022)
Please mail a completed claim form to:
Indiana Soccer Association
19000 Grand Park Blvd, Suite J
Westfield, IN 46074
Certificates of Insurance (COI’s) for Youth Clubs
Beginning September 1, 2021, Clubs may now request additional COI’s using this online request form. CLICK HERE
Insurance Forms – Optional
We would all like to think that employees / volunteers would conduct their organization’s activities with honesty and integrity. Unfortunately, this is not always the case. According to a U.S. Department of Commerce study, one-third of all employees / volunteers admitted stealing from their employers in the previous year.
- Employee/Volunteer Dishonesty Bond Letter from Pullen Insurance, (updated 10/4/2018)
- Employee/Volunteer Dishonesty Bond Coverage Application (Updated 10/4/2018)