Get Individual Registration

Filling out the INDIVIDUAL REGISTRATION form online can be a straightforward process when you follow the right steps. This guide is designed to provide clear instructions for each section of the form, ensuring that users have all the information they need to complete it successfully.

Follow the steps to effectively complete the INDIVIDUAL REGISTRATION form.

1. Click the ‘Get Form’ button to access the INDIVIDUAL REGISTRATION form and open it in your web browser.
2. Begin completing the form by entering the claimant's first and last name in the designated fields.
3. Fill in the address section with the city, state, and zip code where the claimant resides.
4. Provide a telephone number in the next field for contact purposes.
5. Enter the date of birth by selecting or typing in the day, month, and year.
6. Indicate the claimant's role by selecting the appropriate option from the categories provided, such as 'youth', 'coach/manager', or others.
7. Complete the league and team details by entering the names of both in the specified fields.
8. Record the tournament name and type along with the director's name and contact number.
9. Provide the ASA ID card number and ensure to include a copy of the card, if required.
10. Specify the date and time of the accident, selecting 'am' or 'pm' appropriately.
11. Detail the body part that was injured in the designated section.
12. Select the occurrence type by indicating whether the accident took place during a game, practice, tournament, camp/clinic, or other activities.
13. Describe how and where the accident occurred, providing as much information as possible.
14. Use the verification section to collect signatures from the required team or league officials, ensuring they certify the claimant's involvement.
15. Complete the verification from the state or metro commissioner, obtaining necessary signatures and dates.
16. In the statement of other insurance section, provide all required details about the claimant's other insurance coverage.
17. For assignment of benefits, ensure you listen to the instructions provided, indicating any preferences for claims payment.
18. Fill out the statement of certification and authorization by signing and dating the required fields.
19. Finally, review all the entries for accuracy, then save changes, download the form, or print it as needed.

Complete your INDIVIDUAL REGISTRATION online today to ensure you are ready for any potential claims!