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HOW TO FILE YOUR CLAIM 1. 2. 3. COMPLETE THIS FORM WITHIN 90 DAYS ATTACH ITEMIZED BILLS RETURN TO SCHOOL VACo Risk Management Programs 308 Market St., SE Suites 1 & 2 Roanoke, VA 24011 Fax 540-345-5330 or 877-212-8599 Please Print PART 1: SCHOOL INFORMATION School System: School Name: School Address: Student s Name: Male or Female (circle one) Grade Level: Description of Accident? Date of Birth: Time of Injury: Date of Injury: Injury Sustained: If Athletics, please indicate the sport:.

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