Basketball Manitoba Accident Insurance Initial Claim
Full Name of Injured Person
First and Last
Date of Birth of Injured Person
Parent / Guardian Full Name
Only complete if the injured person is under the age of 18 at the time of the accident.
For youth aged claims (under the age of 18 at the time of the accident), please use a parent or guardian's email address. All correspondence will be made using this email address.
Daytime Phone Number
Include the area code. No spaces or special characters.
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