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Injury Report 2023-2024
Please fill this out after a player has been injured.
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* Indicates required question
Email
*
Your email
Date of Injury
*
MM
/
DD
/
YYYY
Players Name
*
Your answer
Your Name (person filling out this form)
*
Your answer
Are you the coach of this player?
*
Yes
No
Your Phone Number (person filling out this form)
*
Your answer
Coaches Name
*
Your answer
Age Group/Team
*
Your answer
Program Name
*
Recreation
Revolution Academy
Travel
Adult League
Field or place where injury occurred
*
Your answer
Field Type
*
Turf
Grass
Field/Weather Conditions
*
Normal/Dry
Wet/Muddy
Uneven
Raining
Other:
Required
Event
*
Game
Practice
Tournament
Other:
Type of Injury
*
Major
Minor
Injured Area on Body
*
Head
Arm
Leg
Ankle
Foot
Other:
Did an ambulance come?
*
Yes
No
Unsure
How did the injury occur?
*
Your answer
What action was taken?
*
Your answer
Is this a recurring injury?
*
Yes
No
Unsure
Do you give permission for this injury information to be shared with the Coach and Technical Staff?
*
Yes
No
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