Please use the following forms and instructions for any injury incurred while at any Little League event, regardless of a practice or game and regardless if you are a player or a spectator.

The Little League insurance policy is not a primary health or accident insurance for your player

IT IS THE RESPONSIBILITY OF THE PLAYER/PARTICIPANT'S PARENT OR GUARDIAN TO SUBMIT THE ACCIDENT CLAIM FORM TO LITTLE LEAGUE INTERNATIONAL.

1. Fill out the form with your coach or manager of your child's team, ensuring all details of the injury are annotated if possible.
2. Contact the Keizer Little League Safety Officer as soon as possible. 
3. The Safety Officer will review the form to ensure ALL required information, including the Social Security number is present.
4. If there is any part of the form that is not filled out that is a requirement, Little League will not process your claim.
5. The Safety Officer will make a copy of the form, present copy to President and give back the injured or their representative the original.
6. All information for the submission of the Accident Claim Form is listed on the form, including the contact information, mailing address, phone number and FAX number are listed for Little League International



Accident Claim Form
Accident Claim Form Instructions