Health and Safety

Nashoba Youth Hockey places top priority on player health and safety. In the event of an injury, our goal is to give our players the best chance to have a positive outcome post-injury.

Please contact Donna Boneck, NYHA Director of Health & Safety or the Nashoba Youth Hockey Board with any questions or for more information.

Consent to Treat Form

Please download and complete this form to upload during the rostering process.

Incidents & Injuries

Nashoba Youth Hockey adheres to the USA Hockey Declaration of Player Safety, which states that:

  • All USA Hockey members must demonstrate awareness and support for the application, spirit and the respect of the rules in order for continued improvement in the game of hockey.
  • Coaches are expected to teach proper skills and hold their players accountable for illegal and dangerous actions, regardless as to whether they are properly penalized, or not.
  • Parents are expected to support the decisions of the officials and support the coaches in teaching the proper skills in a safe and positive environment.
  • Officials shall enforce a strict penalty standard according to the guidelines that have been established.
  • Players are expected to compete within the playing rules.
  • Administrators are expected to hold players, coaches, officials and parents accountable for their actions in an effort to promote a safe and positive environment for all participants.
  • All members of USA Hockey share an equal responsibility to ensure the integrity of the game is upheld. The onus to incorporate change is not only on the officials, but also on administrators, coaches, parents and players, as well. 

Read the full USA Hockey Declaration of Safety, Fair Play & Respect (effective 2019-20 season)

Incident Report Form

To be completed by Coach or Manager

Email completed forms to Donna Boneck, NYHA Director of Health & Safety

Concussion Information

The USA Hockey Concussion Management Protocol and state statutes require that an athlete be removed from any training, practice or game if:

  • exhibiting any signs, symptoms or behaviors consistent with a concussion, or
  • are suspected of sustaining a concussion.

The player should not return to physical activity until he or she has been evaluated by a qualified medical provider who has provided written clearance to return to sports.

  1. Nashoba Hockey requires that the USA Hockey Return to Play form be completed after an athlete has been removed from athletic activity due to a suspected concussion.
  2. The form must be signed by their medical provider and submitted to the Nashoba Director of Health & Safety prior to returning to the ice without restriction to training, practice or competition.

Links to USA Hockey's Concussion Information:

Concussion Management Protocol

Concussion Management Program 

Return to Play form

Complete and email form to Donna Boneck, NYHA Director of Health & Safety.

Insurance Claims

By registering as a member of USA Hockey you are automatically enrolled in the USA Hockey insurance program. The following is a brief description of the insurance policies provided to registered members of USA Hockey.

Tips For Filing a Claim

If you are a registered USA Hockey member and you are injured while participating in a USA Hockey sanctioned activity, follow these procedures:

  • Step 1: At the hospital or doctor’s office, always provide them with your individual, employer health plan, union plan, etc., information as your primary plan.
  • The USAH plan requires that treatment following an injury must occur within 30 days from the injury date.
  • Step 2: The Next Business Day: Call your local program Registrar to request a claim form, or if you do not know who to call locally, please call USA Hockey at 800 566 3288, x123. If you have no other insurance, then your USAH plan will be the primary plan with a $3,500 deductible.
  • DO NOT DELAY getting a claim form or submitting to K&K Insurance. The policy has a timely filing provision and you do not want to jeopardize your claim by not filing within the required time. Upon receipt of your claim, we send an acknowledgement letter and highlights of the coverage/limitations of the plan. By filing your claim after your injury, you are made aware of this information early. DO NOT WAIT UNTIL YOUR PRIMARY INSURANCE HAS COMPLETELY FINISHED YOUR CLAIM BEFORE SENDING IN YOUR USAH CLAIM FORM.
  • Make sure your claim form has been signed in the appropriate places by the appropriate designated persons.
  • Make sure your claim form is submitted along with documentation of your USAH membership.
  • Step 3: Upon receipt of your acknowledgment letter from K & K you should provide the hospital or doctor’s office with your USA Hockey plan information as your secondary plan.
  • By giving all of the medical providers both your primary and secondary information, they will automatically send us the proper itemized medical bill and your primary insurance Explanation of Benefits (EOB), thereby, removing this responsibility from you of collecting the proper information to send with your USAH claim. By following this instruction, your K & K claim administrator will be able to contact the medical providers to request information without being told they cannot release anything to us because we are not on file with them.
  • Whether provided by the medical provider or directly from you, medical bills must be in an itemized format with dates of service, diagnosis codes, and procedure codes.
  • If submitting as a secondary claim, each itemized bill must be accompanied by your primary insurance Explanation of Benefits (EOB), whether this is provided by the medical provider or by yourself.
  • If you have paid any of your medical expenses, please indicate that clearly on the medical bills so that payment will be sent to you.


USA Hockey Summary of Insurance Coverages for Members

Read more at USA Hockey's Insurance Management page

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