When a player is injured at the facility, that player or that player's parent or legal guardian must complete aninjury report.
You can print a form and fill it out, or get the form at the Cafe.
Please complete the form entirely. Directions are included on the last page
of the form.
An incomplete form may hold up the processing of your claim. Turn in
the completed form to the Cafe staff.
The Director of Operations reviews this form and then mails this form to our
Insurance Company:
Bollinger Insurance
P. O. BOX 390
SHORT HILLS, NJ 07078-0390
TELEPHONE (800) 526-1379
Ask for Sports Claims
Do not send any medical bills to KISS. Once KISS submits your paperwork to the insurance company, we are out of the picture.
Thank you for your cooperation.
