Injury Incident Form

THIS FORM IS FOR GAME OFFICIALS ONLY.


For any injuries that occur during a league game, please fill out the following form:

Your Name (*)

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Your Email (*)

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Name of person injured (*)

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Date/Time of Game (*)

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Location of Game

Place

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Town/City (*)

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Provice (*)

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Nature and extent of injuries (*)

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Full description and cause (Include the equipment that the injured player was wearing as it relates to the area of the injury) (*)

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For more severe incidents, Names of Witnesses (include phone number if possible)

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