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Here is a 2 page Safety Information sheet which may be a helpful resource for you.



The AYSO Incident Report Form is used whenever there is a personal injury, damaged property, or threats of actual physical violence surrounding an AYSO game, practice, event or property. The form should be filled out as soon as possible after the incident and should be prepared by the coach, AYSO official or a member of the Region staff such as the Safety Director or event staff members.

If you have a player that is injured during an AYSO activity (and that injury requires medical attention or requires him/her to miss a practice or a game), immediately complete the AYSO Incident Report Form (Attached).  Incident reports are not needed for small injuries that require a bandage, an ice pack or if a player goes back into a game after coming off the field for a short period of time.

Filling out an Incident Report as soon as possible will allow you to capture facts and contact information before witnesses leave the field.  Completion of the form is required by AYSO, and is a prerequisite for the injured participant to be eligible for AYSO insurance.

Please complete the Incident Report in full, including the individual's primary insurance carrier and policy number.  This information is most often omitted.  It is essential information in order for the player/volunteer to be eligible for our AYSO insurance, which is secondary to their primary insurance.  Please provide this information when you submit the Incident Report.  It is not optional.  It is a detriment to the player/volunteer not to include this information.  The Incident Report MUST be completed immediately.  For example, if you have a player injured over the weekend, we need the form Monday morning.



Following an injury, a Release Form will also be required. I will work with you to obtain the correct release depending on the type of injury.

ayso participation_release_form.pdf

The forms you need are attached.  Once completed, please return it to, Dean Dierks, Safety Director, for processing.  You can scan it and e-mail it to  Dean can be reached at 310.413.0722.

Please have these forms available at your practices and games in the event you need them. 

AYSO Region 92 Soccer Accident Insurance for Participants

As part of your participation in AYSO, the Organization purchases Soccer Accident Insurance ("SAI"), which pays excess medical costs up to $50,000 maximum per accident to an insured person for accidental bodily injuries incurred as a direct result of participation in a covered activity subject to the policy terms, conditions and exclusions.  This coverage is secondary to your primary insurance.  Please refer to the attached Soccer Accident Insurance Brochure for a more detailed explanation of the plan.  Additional resources can be found at:

Accident Medical Expense Benefits are only payable if a Claim Form is filed within 90 days of the date of injury.  Claim Forms are available at the link above and should be submitted to the carrier as stated on the form (in addition, an Incident Report should also be filed with Region 92 immediately following an accident or injury).

Benefits include:  $50,000 maximum excess medical costs;$15,000 for Accidental Death & Dismemberment; $10,000 for Dental Benefit for injuries to sound natural teeth; $10,000 for Orthopedic Benefit; and $1,000 Physical Therapy; $100 per day up to 10 days 

All AYSO currently registered* members (players, coaches, managers, team workers, referees, officials and volunteer workers) are "Covered Persons" for accidental bodily injury while participating in the following covered activities:  Team practice sessions, scheduled games, tournaments, or other sponsored activities (meetings, banquets, fundraisers) provided they are under the direct supervision of an AYSO registered volunteer. 

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AYSO Region 92

214 Main St. #507 
El Segundo, California 90245

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