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Insurance and Injuries

Please report all practice or game related injuries to your Coach and the Safety Director (if applicable, if not Regional Commissioner) within one week of the incident if the injury required professional medical attention. Insurance might be available for players and volunteers. Information about insurance and claims forms are available through the Regional Commissioner or to the right under forms. If you have any questions or problems, you may contact us directly.

**Please note that the injured party and/or his or her parents are solely responsible for filing any claim. ** 

**Currently, 955 is seeking someone to hold the Safety Director Position. Please apply if interested. 


AYSO SAI (Soccer Accident Insurance) Claim Form
Form more information about AYSO Soccer Accident Insurance - please click HERE

AYSO Incident Report
The AYSO incident Report Form is used whenever there is a personal injury, damaged property, or threats of or actual physical violence surround 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. 

Participation Release Form (Return to Play)
Whenever a player or youth volunteer has suffered a concussion or an injury or illness that required the care of a physician or a visit to an emergency care facility, the AYSO Participation Release Form must be given to the parents or guardians. The participation release form must be completed in full and signed by the child's parents or guardians before the player or youth volunteer will be allowed to participate further in the program. Questions or Concerns about Forms? Contact us at [email protected].

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AYSO Region 955 - Memphis and Surrounding Areas

PO Box 610 
Memphis, Michigan 48041

Email Us: [email protected]
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