Headstrong Claim Form and Other Insurance Questionnaire 2026

1. Click ‘Get Form’ to open the Headstrong Claim Form in the editor.
2. Begin by filling out the 'Nature' section, selecting either 'Bodily Injury' or 'Other' as applicable.
3. In the 'Time & Place of Incident' section, provide the date, event name, event type, and location. Ensure to specify whether it occurred in the AM or PM.
4. Complete the 'Happened To' section with the individual's name, social security number, date of birth, sex, phone number, and address.
5. Indicate the function of the individual involved (e.g., Athlete) and describe any apparent body part injury or damage.
6. Detail any on-site care received and if an ambulance was required. Specify where they were taken if applicable.
7. Provide a thorough description of what happened during the incident in the 'Incident Description' section.
8. Answer whether there is any other accident medical coverage provided by the school and include details if applicable.
9. Fill out the insured representative's information including name, title, signature, and contact details before submitting.

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