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AYSO Region 92: El Segundo

Safety Information

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

Incident Report Form for Injuries or Other Issues

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.

Injury Release Forms

Following an injury, a Release Form will also be required.  Participation Release Form

The forms you need are attached. Once completed, please return it to our Regional Safety Director, for processing. You can scan it and e-mail it to the email listed on the board members contact page.

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

Player General Release

Once the team coach has assumed charge of the children on his/her team, the coach remains responsible until a duly designated adult has taken charge of each child after a practice or game. No child shall be left unsupervised after a game or practice. Parents who are unreasonably late or consistently tardy may be reported to the Regional Child and Volunteer Protection Advocate (CVPA) for action. Each coach may establish a standing policy of where children may be picked up by late parents. AYSO does not encourage children to walk or ride a bicycle home or to a friend or relative’s house. However, we recognize that it may be necessary in some cases. Neither AYSO nor the coach can be responsible for a child’s safety if they do walk or ride home. A parent or guardian assumes full responsibility for the safety of the child once he or she is released from a practice or game. Please note that this also applies in the case of players who are of legal driving age and transport themselves to and from AYSO activities. If your child will be walking, riding a bicycle or driving themselves home from practice or games, please complete the following in order for your coach to release them:

AYSO 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 specified 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. There is a deductible and percentage co-insurance for the plan. 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).

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

1730 E. Holly Street, #840
El Segundo, California 90245

Email Us: [email protected]
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