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Recruitment Packet 2011
Recruitment Packet 2011 Our MIssion Statement The Omaha Rollergirls (“ORG”) mission is to promote the stregth, athleticism and independence of women through the sport of flattrack roller derby and to provide the skills and training necessary for participation at a regional, national and international level. Furthermore, the Omaha Rollergirls seek to improve the community in various ways through their community outreach events and volunteer work. COMMUNICATION Our most important means of communication is online. We communicate through a Yahoo! forum. If you do not have internet access, please make sure that you have a contact that will call you in case of an emergency or to keep you updated on current events with the ORG. We do not have a calling tree and all updates are available through the forum. YAHOO! FORUMS Bootcamp/VIP/Potential Referee Forums (open to anyone): http://groups.yahoo.com/group/ORGCamp Main Forum upon passing Bootcamp and League Invitiation (by invite only): http://sports.groups.yahoo.com/group/OmahaRollerGirlsForum SOCIAL MEDIA AND ONLINE Web site: www.omaharollergirls.org Facebook: www.facebook.com/Omaha.Rollergirls Twitter: www.twitter.com/OxRxG PRACTICES Practices are held three to four times a week at the ORG practice space, also referred to as the “Bunker”, which is located at 9006-I Maple St., Omaha, NE. We will notify you of any schedule changes as soon as possible through the Yahoo! forum and by verbal announcements at practice. The schedule for 2011 is as follows (subject to change due to coaching committee scheduling): SUN MON TUES WED THUR Noon - 2 pm As needed primarily for Charter/AAA team scrimmages after bouts 7 - 9 pm Endurance Training (all skaters, skating referrees) 7 - 9 pm 7 - 10 pm 7 - 9 pm Scrimmage (all skaters, referees, NSOs) 2 - 4 pm Referee Practice 9 - 10 pm Charter Team Practice As needed Testing/Skills/ primarily use Offskate for skills clinics, Workout/Rookies referee practices, testing and make up practices 9 - 10 pm AAA Team Practice FRI SAT P I H S R E B M ME S T N E M E R I REQU ALL PARTICIPATING SKATERS MUST: N N N N N N Be a female, 18 years of age or older Provide photo ID and proof of health/medical insurance Read and sign the ORG liability waiver (attached) Read the ORG By-Laws and Constitution, sign and return the “Agreement to Comply” page (provided at the recruitment session or beginning of bootcamp) Understand and accept the inherent risks of participating in roller derby Read and understand the current Women’s Flat Track Derby Association (“WFTDA”) Rules and Regulations SKATERS - TO REMAIN ON THE ORG ROSTER: N N N N N Maintain minimum attendance as outlined in our bylaws (as a general rule, that’s an average of 2 out of 3 practices per week) Remain current on dues (detailed below) Meet skating skill and safety standards as determined by the coaching staff and based upon WFTDA Minimum Skills Requirements Bear the expense of all personal equipment, uniforms, dues and travel Abide by the policies/procedures as set forth in the By-Laws MONTHLY DUes Dues in the amount of $35.00 per skater will be collected the 15th day of each calendar month. Dues can be paid in monthly, 3-month and 6-month installments. If you choose to pay in 3-month installments the cost of dues is $90 (saves $15) and 6-month installments the cost of dues is $170 (saves $40). INSURANCE Womens Flats Track Derby Association (“WFTDA”) is the international governing body for women’s flat track roller derby. All league members – skaters and referees – are responsible for obtaining an annual membership of insurance coverage with WFTDA (averaging $55.00 per skater.) The insurance dues are required to be paid before you are allowed to participate in bootcamp and is renewed on an annual basis in lieu of dues for that month. We strongly encourage everyone to obtain primary insurance outside of the WFTDA insurance. ATTENDANCE New skaters are required to maintain a minimum of 50% attendance for two months to submit a derby name once accepted to the league. Attendance of at least 60% is required to be considered for placement on a team, as well as passing all skills assessments. Any skater whose attendance falls below 30% will be dismissed from the league. SAFETY ALL protective gear must be worn during all skating activities. This includes knee pads, elbow pads, wrist guards, helmets and mouth guards. Additional protective gear such as ankle support and tailbone protectors should be taken into consideration. Skating under the influence of drugs and/or alcohol will not be permitted at ORG practices or during bouts. PRotective gear required gear - What you will need to SKATE KNEE PADS Brands: Common brands include Triple 8, TSG, Rector, Pro-Tec, S-One and Scabs. Please note: Rector’s come in “standard” and “fat boy”. The “fat boys” have more padding and covers more of the knee. If you have a previous knee injury or want more protection and support, we recommend the “fat boys” or wearing a gasket underneath your kneepads that will keep your knee pad from slipping. Where can I purchase: Triple 8, TSG, Rector, Pro-Tec, S-One can be found at local skate shops or online and Scabs can be acquired by the ORG league. Care and replacement: Air out your pads after each practice. Replace at least once a season. Inspect for rips or signs of the padding material wearing away or breaking down. ELBOW PADS Brands: Common brands include Triple 8, TSG, Rector, Pro-Tec, S-One and Scabs. Look for options that are fabric. Plastic with velcro is not enough protection. Where can I purchase: Triple 8, TSG, Rector, Pro-Tec, S-One can be found at local skate shops or online and Scabs can be acquired by the ORG league. Care and replacement: Air out your pads after each practice. Replace at least once a season. Inspect for rips or signs of the padding material wearing away or breaking down. NOT REQUIRED BUT A GOOD IDEA to have N N N N N N N WHERE TO BUY YOUR EQUIPMENT WRIST GUARDS Brands: Common brands include Rector, Pro-Tec, Triple 8 and TSG. Where can I purchase: Online, skate shops, sporting good stores. Care and replacement: Air out your pads after each practice. Replace at least once a season. Inspect for rips or signs of the padding material wearing away or breaking down. HELMET Brands: Your helmet should be designed for multiple impacts (bicycle helmets are not). Most skateboard helmets are appropriate. The recommended brands are Triple 8 or S-One. Where can I purchase: Online, skate shops, sporting good stores. Care and replacement: If you receive a head injury replace your helmet. Depending on the helmet you can replace the padding inside the helmet if after washing the smell does not go away. MOUTHGUARD “Boil & Bite” mouthguards, such as Shock Doctor or Tap Out are pretty inexpensive. People with smaller mouths may find a child size more comfortable. You can also contact your dentist for a custom mouthguard. It will be more expensive but if you have braces or have already spent a lot of money making your smile pretty, custom is the way to go. Where can I purchase: Any sporting good store, online at tapoutmouthguard.com. Care and replacement: Replace every 3-4 months. Brush it often with a toothbrush or soak in mouth wash. Make sure that the mouth wash is not alcohol based as it will wear down the plastic/silicon material quickly. SKATES Brands: Quad speed skates come in men’s sizes; you will need a size that is approximately 1-2 sizes smaller than your own shoe size. When looking for a size ask to try on someone else’s skate as the team owns a variety of sizes and styles that can help you find the right skate. Most importantly, ask questions! Everyone has different feet and most of the skater’s have been through the buying-and-breaking-in-process. We may be able to save you from an expensive mistake. For vinyl skates we recommend R3, Carreras or Boxers (range from $100-$150). When you want to upgrade to a leather boot we recommend the Riedell 265’s (around $300). Where can I purchase: Online, skate shops. GASKETS - keeps knee pads from slipping and adds an extra layer of protection SHIN GUARDS OUTDOOR WHEELS - usually a grippier wheel used for trail or outdoor skating BANDANAS - helps to soak up sweat under your helmet SHOE LACES - typically you want 70 inches in length and a sports driven construction DUCT TAPE 3 IN 1 OIL - for bearings N ONLINE sincityskates.com lowpriceskates.com rollergirlskates.com wickedskatewear.com rudechix.com Talk to the sponsorship director if you plan to use one of these sites. Many offer 10-15% discounts and free/discounted shipping with a league code. N SKATE SHOPS BBB Skate Shop 5030 Underwood, Omaha 402-933-9113 BC Boardsports Westroads Mall 10000 California, Omaha 402-390-2398 Next Generation Secret Spot 529 N 78th St, Omaha (south of Roberts Skatepark) 402-391-6398 7704 S 36 St, Bellevue 402-933-1301 ? N O G N I O G S I K C E H E H T T a h W HEET S T A E H C Y B R E D R A ROLLE Typical HOW DO YOU WIN THE GAME (A.K.A. BOUT)? The team with the most points after two 30-minute periods wins the game. Each period is made up of individual “jams” lasting no longer than two minutes. Jam Line WHEN DOES GAME PLAY STOP? s When a team calls a time-out, the referees need to discuss a call and an “official time-out” is taken or when a severe injury stops the jam. ERS JAMM second n Start o tle is h two w HOW DO YOU SCORE POINTS? The sprinting skater with a star on her helmet is the jammer. Each team has one jammer. The jammer is the only skater who can score points by passing blockers on the opposing team. If jammers are not in bounds or they make illegal contact with opposing skaters while passing, they do not score points. Also, jammers do not score on their first pass through the pack. ERS BLOCK first n o Start le t whis WHO ARE THE BLOCKERS? There are four blockers from each team on the floor at one time. Together, the eight of the blockers make a pack. Blockers play offense by assisting their jammer at the same time play defense and block the opposing jammer. WHY DOES ONE GIRL HAVE A STRIPE ON HER HELMET? The girl with the stripe is called the pivot. The pivot is a blocker who sets the pace of the pack. She watches for the opposing team’s jammer and calls out plays accordingly. If a jammer passes her star helmet cover to the pivot, the pivot can take over the jammer position. WHAT’S A LEAD JAMMER? The lead jammer is the first jammer to pass through the pack legally. The lead jammer is the only person who can call off a jam prior to the full two minutes. She calls off the jam by repeatedly placing her hands on her hips. The lead jammer is identified by a jammer ref pointing to her with “L” shaped arms while following beside her inside the track. Sometimes there will be no lead jammer and the jam will last the full two minutes. LEAD JAMMER WHY ARE GIRLS SENT TO THE PENALTY BOX? Girls are sent to the penalty boxes because they have accumulated four minor penalties or committed one major penalty. The difference between a major and a minor penalty is whether the violation causes a “change in play” or gives the offending team a scoring advantage. The penalty time starts once the girl sits in the seat, so it’s essential that she get to the penalty box quickly once assessed a penalty. The standard time in the box is one minute, but girls can do extra time for getting sassy with the refs. WHAT ARE EXAMPLES OF MINOR FOULS? • • • • Hitting an opponent with forearms Hitting an opponent with an elbow Hitting an opponent in the back Hitting an opponent when she is out of bounds WHAT ARE EXAMPLES OF MAJOR FOULS? • • • • Fighting Insubordination to a referee Giving a malicious or dangerous illegal hit Acting with gross unsportsmanlike conduct See www.wftda.com for official rules and minimum skill requirements. FAQ’s HOW DO I GET A DERBY NAME? WHAT CAN I DO AHEAD OF TIME TO PREPARE? You “earn” your derby name upon graduation of bootcamp, confirmation that all testing has been passed and you’ve maintained a 50% attendance for two month prior to submission. Once you have come up with your name and number check the National Derby Name Registry to ensure that the name is available. Once you’ve confirmed that it is available you will submit it to the Recruitment Director and she will submit it to the registry. To view the registry please visit www.twoevils.org/rollergirls/?c=3. So you’re ready to attend boot camp but see that it’s a couple of months away. We suggest that you begin conditioning your body for what lies ahead by starting some of the following activities: • WHAT CAN I EXPECT THE FIRST PART OF BOOTCAMP? • As outlined in the WFTDA Minimum Skills Requirements (see attached) you will be put through drills and training during the first five weeks of bootcamp that are geared to help you pass the first three sections of skills - Basic Skating, Falls and Balance/Agility. • There will also be breakout sessions, such as “How to Care for and Maintain your Skates”. Upon successful completion of this section of skills you will move on to the second part of bootcamp. WHAT CAN I EXPECT THE SECOND PART OF BOOTCAMP? As outlined in the WFTDA Minimum Skills Requirements (see attached) you will be put through drills and training during the second five weeks of bootcamp that are geared to help you pass the next six sections of skills - Skating with Others, Blocking and a written Rules test. What can you hit with? • SKATE - Order your skates and protective gear ahead of time and get to as many open skating sessions as possible. There is nothing better to ensure your success as a “Fresh Meat” than having confidence on your skates. CONDITION - Get your core and legs stronger now. We suggest starting with short sets of crunches, push-ups, squats, lunges and leg lifts. Start small and build up your sets slowly over a couple of weeks. CARDIO - you will thank us later for this tip. Getting on skates is good but speed walking, jogging, taking an aerobics class or spending some time on a stationary bike will also increase your endurance while you wait for boot camp. LEARN - Get on the internet and look it up! There are many resources about derby and You Tube has a ton of videos of derby in action. Whether it’s watching tutorials on how to do crossovers or watching some of the best leagues in the nation play, taking this time now to learn will only help you once you get out on the track. Where can you hit? S E I T I N U T R O P P O OTHER IN THE ORG If you decide that the sport of Roller Derby is not for you because of the committment, injuries or other conflicts, please know that you can still participate. Also, even as a skater you may have friends or a “derby widow” or spouse that would like to help. We are always looking for supporters and we greatly appreciate any interest in the ORG. Please contact the Recruitment Director for other opportunities within our league. So, where could you help? ORG ARMY These individuals will assist with bout production such as “Talk Derby” girls, merchandise sales, program sales, track set up and much more. NON SKATING OFFICIALS These individuals are officials who are off skates and manage the bouts with duties such as: Jam Timer: The Jam Timer will be responsible for starting the jam, ensuring that jams do not go longer than two minutes and timing timeouts. Point Trackers: tracks points for the referees. Penalty Wrangler: takes in penalties from out side white boards and watch/listen to Inside Pack Refs for penalties. Penalty Tracker: documents BOTH teams penalties to the official penalty sheet and relays to Large White Board Operator how many penalties every player has accumulated. Large White Board Operator: marks the penalties on a white board for the teams to see how many penalties each player has. Outside Penalty White Board: marks the penalties on a white board giving to them by Outside Pack Ref to relay Penalty Wrangler. Penalty Box: sets up between benches, but arranged so they are on opposite sides of own team. REFEREES Seven Positions are used to cover the Jammers and the Pack: Outside Pack Check: checks for passes OOB (Out of Bounds), penalties and out of plays. Jammer Refs: Watches the Jammers for any penalties that are made toward them or around them, tracks points. Inside Pack Refs: Watches for inside pack penalties. PACK IS HERE! WHO TO CONTACT Coaching - Midlife Crashes, [email protected] Recruitment - Nic-Rageous, [email protected] PR - Soul Crusher Sally, [email protected] Sponsorship - Shaw No Fear, [email protected] Finance - Sharon Misery, [email protected] Events - Daisy Mayhem, [email protected] Merchandise - Bruiseberry Muffin, [email protected] Special Events - Miss Judged, [email protected] Head Referee - Crash Hartless, [email protected] Emergency Medical Release & Liability Waiver Participant’s Name _____________________________________________________________________ Date of Birth __________________________ Phone ________________________________________ Street Address _________________________________________________________________________ City/State/Zip Code ____________________________________________________________________ Emergency Contacts Emergency Contact _______________________________ Home Phone __________________________________ Relationship ______________________________ Cell Phone ___________________________________ Alternate Emergency Contact _____________________________ Relationship ________________________ Home Phone __________________________________ Cell Phone ___________________________________ Allergies _________________________________________________________________________________________ Medications _____________________________________________________________________________________ Other Medical Conditions _______________________________________________________________________ Insurance Information Primary Physician _______________________________________________________________________________ Address _____________________________________________ Phone ___________________________________ Insurance Provider ___________________________________ Policy/Group Number ____________________ Policy Holder’s Name ________________________________ Relationship to Participant _______________ Hospital Preference _____________________________________________________________________________ THIS AUTHORIZATION FOR EMERGENCY MEDICAL TREATMENT MUST BE COMPLETED BEFORE PARTICIPANT (PLAYER/COACH/REFEREE) CAN PARTICIPATE IN ACTIVITIES. TREATMENT FOR INJURY WILL BE BASED ON INFORMATION PROVIDED HEREIN. In consideration of participation in any roller derby competition conducted under the auspices of Omaha Rollergirls ("ORG"), its member unions, clubs, organizations and individuals (the "Activity"), I, the undersigned, agree that: 1. I understand the dangers that may be caused by my own actions or inactions, the actions or inactions of others participating in the Activity and the conditions under which the Activity is conducted. I understand the nature of the Activity and acknowledge that I am qualified to participate in such Activity. I further acknowledge that I am aware that the Activity will be conducted in facilities open to the public during the Activity. I further agree and warrant that, if at any time, I believe conditions to be unsafe; I will immediately discontinue further participation in the Activity. 2. I acknowledge that I have a medical insurance policy in my name and that such insurance will be my primary source of payment should medical treatment be necessary as a result of my participation in the Activity. 3. I will not participate in any league bout or competition without first meeting the Minimum Skills Requirements as set out by the Women's Flat Track Derby Association ("WFTDA") which is available in its most current form on the WFTDA website (www.wftda.com). 4. I FULLY UNDERSTAND that: (a) the Activity involves risks and dangers of SERIOUS BODILY INJURY, INCLUDING PERMANENT DISABILITY, PARALYSIS AND DEATH ("Risks"); (b) there may be other risks and social and economic losses either not known to me or not readily foreseeable at this time; and I FULLY ACCEPT ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES, COSTS AND DAMAGES incurred as a result of my participation in the Activity. 5. I HEREBY RELEASE, DISCHARGE, COVENANT NOT TO SUE AND AGREE TO HOLD HARMLESS Omaha Rollergirls, its respective administrators, members, directors, agents, officers, volunteers and employees, local organizing committees, other participants, any sponsors, advertisers, if applicable, owners, and lesser of premises on which the Activity takes place (each considered one of the Releases herein) from all liability, claims, demands, losses, or damages on account caused or alleged in whole or in part by any act or omission of the Releases in connection with the Activity or otherwise, including rescue operations, and further agree that if, despite this release, I or anyone on my behalf makes a claim against any of the Releases named above, I WILL INDEMNIFY, SAVE AND HOLD HARMLESS EACH OF THE RELEASEES FROM ANY LITIGATION EXPENSES, ATTORNEYS FEES, LOSS LIABILITY, DAMAGE OR COST ANY MAY INCUR AS THE RESULT OF SUCH CLAIM. 6. I agree to abide by all Women's Flat Track Derby Association ("WFTDA"), Omaha Rollergirls ("ORG"), territorial and local area union rules and regulations. 7. I affirm that I am not suspended or banned from play or participation by any club local area union, territorial union, or national union. 8. I am aware that Omaha Rollergirls has the right to revoke my membership in the league, and therefore my eligibility to play, coach, or otherwise participate in the event of any violation of the aforementioned statement. 9. I understand that this document may not be altered in any manner and that any alternation without the express written consent from the Omaha Rollergirls will cause me to be removed from the Program. I HAVE READ THIS AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND HAVE SIGNED IT FREELY WITHOUT ANY INDUCEMENT OR ASSURANCE OF ANY NATURE AND INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW AND AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE INVALID THAT THE BALANCE, NOTWITHSTANDING, SHALL CONTINUE IN FULL FORCE AND EFFECT. (Revised 07/23/10) Participant's Signature __________________________________________________________________________ Printed Name ___________________________________________________________________________________ Date _______________________________ NOTE: ATTACH A PHOTOCOPY OF YOUR INSURANCE CARD, FRONT AND BACK, TO EXPEDITE MEDICAL TREATMENT. !"#$%&'()(*+*&,-(../&012+(31*1)4/ 513/(6)&789 :;<=41<&>+.?&@AB&799C !"#$$%"&'()*+,"-./0"12/34"5)267"8,,'39/09'*":&-158; </3="&-158"()(6)2".)/>?)"0=/0"9*0)*@,"0'")*0)2"9*0'"/"&-158A,/*309'*)@"9*0)2.)/>?)"6'?0 (?,0"@),9>*/0)"/".)/>?)"()(6)2"B='"9,"2),C'*,96.)"D'2")*,?29*>"0=/0")/3=",4/0)2")*0)29*>"9*0' 0=)"9*0)2.)/>?)"6'?0"())0,"0=)",49.."2)E?92)()*0,".9,0)@"6).'BF"1=)".)/>?)"()(6)2"(/7"6)"0=) =)/@"'D"0=)"02/9*9*>G3'/3=9*>"3'((900))H"02/I)."0)/("3/C0/9*H"'2"'0=)2".)/>?)"'DD939/.F"1=9, @),9>*/0)@".)/>?)"'DD939/."(?,0",9>*"'DD"'*")/3=",4/0)2+,"9*@9I9@?/."/,,),,()*0",=))0F J4/0)2, (?,0"6)"/,,),,)@"C29'2"0'"0=)92"D92,0"9*0)2.)/>?)"3'(C)0909'*"/*@"2)A/,,),,()*0,"(?,0"6)"@'*)"/0 .)/,0"/**?/..7"0=)2)/D0)2F &-158".)/>?),"(?,0"(/9*0/9*",9>*)@"2)3'2@,"'D",?33),,D?."0),09*>"'D 0=)92"2',0)2)@",4/0)2,"/*@"6)"/6.)"0'"C2'I9@)"0=),)"2)3'2@,"0'"0=)"&-158"?C'*"2)E?),0F K"L/,93"J4/09*>"J49.., 1=)",4/0)2"(?,0"@)('*,02/0)"C2'D939)*37"9*"0=)"D'..'B9*>"/2)/,M KFK"J4/09*>"N',0?2) KFKFK"L)*@,"/0"4*)),"/*@"=9C,"B90=",='?.@)2,"6/34 KFKF#"JB9*>,"/2(,"[email protected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email protected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`/2@ D'2"/*7"'D"0=)"C/34",4/0)2,F SFW"U)/*9*> SFWFK"J4/0),"B=9.)".)/*9*>",='?.@)2"0'",='?.@)2"B90="/*'0=)2",4/0)2"B=9.)"(/9*0/9*9*>"/* ?C29>=0"C',909'*"/*@"C2'C?.,9'*"B90='?0"029CC9*>H"D/..9*>H"'2"6)3'(9*>"?*,0)/@7F SFa"L?(C9*> SFa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`/2@"D'2 C/34",4/0)2,F TF#"N',909'*/."L.'349*>G-2'*0/."L.'349*>GJ0/.."L.'349*> TF#FK"N)2D'2(,"B90=">''@"C',0?2)"/*@"B90='?0".',,"'D"6/./*3)"'2"D'3?, TFQ"R=)34, N)2D'2(,"3=)34,"B90=".)>/."6'@7"C/20,"@).9I)2)@"B90=9*".)>/."6.'349*>"`'*),"B90="('@)2/0)"0' =)/I7"D'23)"B=9.)",4/09*>"/0"/"629,4"C/3)F TFQFK"O9C"3=)34, TFQFKFK"U)D0"=9C TFQFKF#"Z9>=0"=9C TFQF#"J='?.@)2"3=)34, TFQF#FK"U)D0",='?.@)2 TFQF#F#"Z9>=0",='?.@)2 !"#$$%"&'()*+,"-./0"12/34"5)267"8,,'39/09'*":&-158; WFTDA Insurance Claim Procedures Definition of Claim Types: 1. Excess Medical – An Excess Medical Claim should be filed when an injury to a plan participant (herein referred to as injured party) occurs. 2. General Liability – A General Liability Claim should be filed when an injury occurs to a spectator (herein referred to as spectator) at any venue in which the League has obtained a Certificate of Insurance. **Whether League is filing an Excess Medical or General Liability Claim, the WFTDA Safety Protocol MUST be followed or the claim will be denied. SAFETY PROTOCOL IS NOT A SUGGESTION, IT IS A REQUIREMENT!** All required Forms MUST be completed IN FULL or the claim will be denied! Procedures for Filing an Excess Medical Claim IMPORTANT Please Note: Participants who do not have primary policies create a huge liability for the WFTDA group policy due to high pay-outs. Simply a handful of skaters without primary insurance can create claims that cost more then the amount of the actual policy. This will cause all leagues an increase in future insurance costs and deductibles, as well as a possible future decrease in the coverage offered. It is highly recommended that all participants have primary coverage as the WFTDA group insurance is meant to be used as SECONDARY supplemental coverage! It is only designed to cover expenses that are NOT covered by the injured parties’ primary policy. 1. Within 14 days of an injury occurrence, the League Insurance Rep must turn in a completed WFTDA Accident Report. Report should be emailed to [email protected]. All fields MUST be completed! A step-by-step explanation of the required fields can be found at the end of this document. a. WFTDA Insurance will provide the Accident Report to sportsinsurance.com. Please do not submit claims independently. b. League Insurance Rep MUST keep copies of all forms submitted to the WFTDA. c. 2. The injured party should collect and keep all copies of ITEMIZED medical bills along with copies of the Explanation of Benefits (EOB) from the primary insurance company for submission to the claims department. Once the injured parties’ primary coverage has paid at the maximum coverage, it is the responsibility of the injured party to notify the WFTDA Insurance Committee when expenses are incurred that are not covered by the primary policy or plan. The injured party will be sent the claims forms A and B with instructions. When the paperwork is received the injured party will work directly with sportsinsurance.com’s claims department. Notification should be emailed to [email protected] ©2009 Women's Flat Track Derby Association (WFTDA) ***Note: for participants with Primary Coverage: Eligible covered expenses will be paid ONLY if they are in excess of other valid and collectible insurance or medical payment plans. If the injured party is covered by any other insurance or medical payment plan, she must first submit claim to the primary insurance. ALL deductibles and co-pays on injured parties’ primary plan are her/his own responsibility. Procedure for Filing A General Liability Claim General Liability suits can result in the claimant requesting more than just medical expenses. Sometimes these suits are referred to as a “Slip and Fall” suits. The parties that can be named in these kinds of suits are: The covered League, WFTDA, the covered venue and any other associated organizations (ie: venue management, event hosts, cohosts and sponsors). The General Liability coverage will provide the lawyers needed for this type of claim. If a claimant can prove the host(s) did not provide a safe environment and/or the injury was sustained by an issue that could have been prevented by the host(s), these suites can cost thousands or even hundreds of thousands of dollars. To date there have been zero General Liability claims to any WFTDA member leagues! The accident report can be found in the peanut. It should be completed by the League Insurance Rep. WFTDA Insurance Chair must be notified immediately and should be copied on all paperwork including any paperwork submitted to the host venue, or from the host venue. Step-by-Step Instructions to Complete the Accident Report (ALL fields must be completed!) ID#: I. If the General Liability Claim is for participant medical only, use the League’s Insurance Certification Number. This can be found on the Certificate of Insurance that has your league ONLY listed. II. For a General Liability Claim that is for an injured spectator, use the ID# that is listed on the Certificate of Insurance that lists the specific venue where the injury took place. The following details what information should be completed in the fields on the Accident Form with the corresponding number referenced: 1. 2. 3. 4. 5. The Policy Holder is the hosting league's certificate number IF a WFTDA member League is hosting. The Policy Holder is the visiting WFTDA league's certificate number if a USARS league is hosting. Address of hosting League Visiting League name Address of visiting League Exact address where injury occurred. (If this is a General Liability Report, it MUST be the address listed on the Certificate of Insurance for that Venue.) a. b. c. d. e. f. All Personal information must be completed Detailed description of the incident, injury AND treatment must be completed MUST answer if there is a Primary Policy MUST list who the certified on-site EMT was. It is a beneficial practice to have witnesses. It is best if the highest official on-site is able to sign as a witness. The League’s Safety Coordinator MUST sign the form. By signing, the Safety Coordinator is stating that the safety protocol requirements have been met for this incident. The Safety Coordinator does not need to be a witness, but must confirm with the witnesses that the safety protocol requirements were met. (The Safety Coordinator may also be the League Official.) ©2009 Women's Flat Track Derby Association (WFTDA) RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT ("Agreement") I HAVE READ THIS RELEASE Adult W&R 6/22/07
