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

Insurance Claims for Adult League Players

Click here to obtain the necessary forms.  Scroll down the page until you reach the section on insurance forms.

1. Print and complete the claim 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 you were injured in needs to accompany the form.  Contact John Waizenhofer ( This e-mail address is being protected from spambots. You need JavaScript enabled to view it ) for the report.
4. A League Official will need to sign off on the entire package before it's submitted to  Peggy Polley   KSA President   10809 Oreland Mill Road  Louisville, KY 40229

If you have questions, feel free to email me (Nina O'Leary) at This e-mail address is being protected from spambots. You need JavaScript enabled to view it or call 859-223-1454.