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W9 Federal Form   W-9 form for referees, paid coaches, contract labor.

Insurance Claims for Adult League Players:

Click below to obtain the necessary forms.

  1. Print and complete all three pages of the Special Risk Accident Form.
  2. Contact Lois Stephens, LYSA Registrar  ( This e-mail address is being protected from spambots. You need JavaScript enabled to view it ) for verification of your registration.
  3. The referee report from the game in which you were injured is required, and is sent under separate cover.  Contact John Waizenhofer ( This e-mail address is being protected from spambots. You need JavaScript enabled to view it ) to ensure this was sent to KSA.
  4. A league official will need to sign off on the entire package before it's submitted.  
  5. Once all of the above steps is complete, mail your claim to: 

Peggy Polley, KSA President  

10809 Oreland Mill Road 

Louisville, KY 40229

 

Forms:

Special Risk Accident Form

Liability Coverage English

Liability Coverage Spanish

 


If you have questions, feel free to email me (Tracey McGaughey) at This e-mail address is being protected from spambots. You need JavaScript enabled to view it or call 859-223-5632.

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