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As of September 1st, 2018, K & K Insurance Group, Inc. is proud to be the official insurance program administrator for Iowa Soccer Association, Nebraska State Soccer Association and Kansas Youth Soccer. 

Youth Soccer-Related Insurance Information

Report an Incident and Certificate:

  • To report an incident, fill out the Incident Report Form and email or mail to Phil Gomez, Director of Membership.
  • To request a "Certificate of Insurance" see bottom of page for instructions.


Claim Procedures
In the event of injury requiring medical treatment, you should:

  • Fully complete a claim form verified by a witness and submit it to Kansas Youth Soccer for verification
  • Notice of claims must be filed within 90 days from the date of injury.

Youth Soccer Accident Medical coverage is provided on an "excess" basis.  Therefore, charges must first be submitted to any other medical insurance carrier available to the participant. 




If the incident occurred during the 2018-2019 seasonal year please fill out the forms below. 


Click the link below to fill out your form.

Pullen Incident Report Form 2018-2019 (Type In Version)



If the incident occurred during the 2019-2020 seasonal year please fill out the forms below. 

Pullen Incident Report Form 2019-2020 (Type In Version)



Once you completed the Pullen Incident Report Form please mail or email to Kansas State Youth.  Once approved by Kansas Youth Soccer it will be passed on to K&K Insurance who will then forward an acknowledgement form advising you of receipt of your claim.  All future correspondence concerning your claim should be directed to K&K Insurance at the address and phone number listed on your acknowledgement form.



Phillip Gomez
Director of Membership & Marketing

10529 South Warwick St. | Olathe, KS 66061
913-782-6434 x 203
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Current certificates of insurance are effective from September to August of each year for registered affiliate members.  Certificates of insurance for the next seasonal year will be dated as such and should be available by the last week of August once K&K Insurance has received the insurance information from the underwriters and coverage is bound with the state association.


If you are a KSYSA League Administrator, to submit a request for certificate of insurance please be sure you have the information below gathered together and submit your request using the google doc form link below.


Certificate of Insurance Request Form


Name of Affiliate Member League/Club

Name of League Administrator Making Request

Name of Location for Certificate (i.e., Swarner Park, USD 259)

Complete Address of Location (Street Address, City, State, Zip Code)


This email request should only be completed by a League Administrator, not by parents or coaches.


If you have not received the requested insurance certificate within 48 business hours, please contact us at



Kelly Morgan

Executive Assistant 

10529 South Warwick St. | Olathe, KS 66061
913-782-6434 x 202
KSYSA Executive Assistant Shield USYS Primary Vert Small Email


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