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
Bartlett - 1131327
Central District Girls Softball - 292399
Crystal Lake - 1131304
Elgin Classic - 1131308
Elgin National - 1131309
Hanover Park - 1131321
Huntley - 151602
Kaneland - 293080
Libertyville - 1131604
Marengo - 1131315
Northwest - 168572
South Elgin - 1131316
Streamwood - 1131318
Tri-Cities - 1131305
Woodstock - 1131319
Name of League Personnel Submitting Form
Email of League Personnel Submitting Form
Location Where Injury Occurred
Date Injury Occurred
Injured Player's Division of Play
Injured Player's First and Last Name
Injured Player's Date of Birth
Injured Player's Parent First and Last Name
Brief Description of Injury
Brief Description of How Injury Occurred
Has a Medical Claim Been Filed with Little League International?
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This form was created inside of Illinois District 13.