JPH Injury Report
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Email *
Name of evaluating ATC *
Date *
MM
/
DD
/
YYYY
Time *
Time
:
Athlete First Last Name *
Age Division *
Club Name *
Parent Name & Phone number *
The Injury: what is the injury, how did it occur, and what tests you performed. *
Assessment & Plan of action. If athlete is not cleared to return to play, provide a brief explanation *
Is the athlete cleared to return to competition? *
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