INSURANCE COVERAGE AND FORMS
As of September 1st, 2018, Pullen Insurance Services 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
Coverage and Certificate
- Summary of Coverage
- To request a "Certificate of Insurance" see bottom of page for instructions.
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.
TO REPORT AN INCIDENT
CLICK HERE to review insurance guidelines that Affiliate members should follow and a summary of the insurance program. The information contained in the summary is intended to serve only as an outline of the various insurance coverage. Reference will be made to the respective policies for complete details and the terms, conditions, limitations and exclusions of coverage.
ALL INCIDENTS ON AND AFTER SEPTEMBER 1st, 2018
Click the link below to fill out your form.
Pullen Incident Report Form (Type In Version)
Pullen Incident Report Form (Write In Version)
Once you completed the Pullen Incident Report Form please mail or email to Kansas State Youth
Director of Membership
10529 South Warwick St.
Olathe, KS 66061
CERTIFICATES OF INSURANCE - FOR TEAMS ONLY
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 ESIX 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
913-782-6434 x 202