Injury Notification Submission Form
This form is for leagues within IL District 13 to submit when a player from their League incurs a serious injury. Completion and submission of this form notifies District 13 of the incident. Each league is still responsible for using the standard Little League International Accident Claim Form Process.
League Submitting Notification *
Name of League Personnel Submitting Form *
Your answer
Email of League Personnel Submitting Form *
Your answer
Location Where Injury Occurred *
Your answer
Date Injury Occurred *
MM
/
DD
/
YYYY
Injured Player's Division of Play *
Injured Player's First and Last Name
Your answer
Injured Player's Date of Birth *
MM
/
DD
/
YYYY
Injured Player's Parent First and Last Name *
Your answer
Brief Description of Injury *
Your answer
Brief Description of How Injury Occurred *
Your answer
Has a Medical Claim Been Filed with Little League International? *
Submit
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