Liability Incident Claim Form

Please note this form should be used by USAL member organizations when a general liability incident (property damage or bodily injury during a covered lacrosse activity) has occurred.

If you are a USAL player, coach or official member, have been injured during a covered lacrosse activity and would like to file a personal injury claim, then please use this link: USA Lacrosse Injury Report

Incident Details

Your First Name

Your Last Name

Claimant Email Address

Claimant Phone Number

Lacrosse Club Name

Date of Incident

Description of Incident

Incident Location (name and address of facility/field)

Note: Coverage only applies to US Lacrosse, Inc. (dba USA Lacrosse, “USAL”) events involving USAL National teams, leagues, camps, clinics, tournaments, and officials and coaches associations, provided they follow 100% registered member guidelines set forth by USAL.

Please include any relevant attachments (for example, third-party demand, correspondence from a legal firm, legal complaint, or similar document) if applicable.

Unlimited number of files can be uploaded to this field.
256 MB limit.
Allowed types: gif, jpg, jpeg, png, bmp, txt, rtf, pdf, doc, docx, xls, xlsx.

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