HvZ Injury Reporting Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

This form is for players who have received an injury while participating in gameplay. If you have received an injury, please complete this form AND report to Student Health Services immediately.

If an injury was received due to a gameplay rule violation, please complete the following form as well: Rule Violation Reporting Form

For any questions, please contact Game Administrator, Sam Hauser, at shauser@uncp.edu.

Full Name *

Banner ID *

Bravemail Address *

Player Code *

Please describe the injury received. *

Please describe how the injury occurred. *

Have you already reported to Student Health Services? *

Yes

Would you say this injury was due to a gameplay rule violation? *

Yes

If you responded yes to the previous question, please complete the Rules Violation Reporting Form.

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of UNC Pembroke. Report Abuse

Forms