Website Manager

The Premier Soccer Club for Northeast Georgia

Injury Reports

The Injury Report needs to be electronically completed by the coach, not the parent. 

The coach should fill out two injury forms: One to RFC and a second to GA soccer.  

Click Link for Rapids FC Injury Report:

Click Link for the Georgia Soccer Injury Report:  Pullenins Accident Medical Claim form.

  1. Complete all questions on the Accident Claim FormNote: This must be done by a coach, assistant coach, or team manager.
  2. File this new report of claim within 30 days of the date of the accident or as soon thereafter as is reasonably possible.
  3. Once the injury form received and approved, an email with the claim form will be sent to the parent. 
  4. If you have other insurance, submit your itemized bills to the other carrier first. You will receive a payment Explanation of Benefit worksheet (EOB) from your carrier. Do not wait until your other carrier has processed all your bills before filing a Youth Soccer Accident Claim Form.
  5. You may attach itemized bills and your other carrier’s EOBs that are ready at the time of submitting this Claim Form.
  6. Upon receipt of the claim form from your state association, we will forward an acknowledgment form advising you of your claim. All future correspondence concerning your claim should be directed to K&K Insurance, who is the claims payor for National Union Fire Insurance Company, at the address and phone number listed on your acknowledgment.