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Each itemized bill MUST show the following:

Each itemized bill MUST show the following: 2026

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The document outlines the guidelines for submitting a Youth Soccer Accident Claim Form to the Arkansas State Soccer Association. It details the necessary steps for completion, including obtaining signatures, filing timelines, and requirements for itemized bills. The document emphasizes the importance of timely submission and provides instructions on how to handle claims involving other insurance carriers. Additionally, it includes frequently asked questions regarding itemized bills and claim processing.

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Click ‘Get Form’ to open the Youth Soccer Accident Claim Form in the editor.
Complete all questions in Section I, including claimant details and accident information. Ensure accuracy for a smooth processing experience.
In Section III, have the coach or local official who witnessed the accident sign to verify the incident.
Sign Section VI, which is the Statement of Certification/Authorization to Release Information, confirming that all provided information is accurate.
Attach any itemized bills and Explanation of Benefits (EOB) from other insurance carriers if available, ensuring they meet the required details outlined in the guidelines.
Submit your completed claim form to your State Association for verification and authorized state signature.

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