SBP Incident & Injury Report

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Please provide South Bay PONY with the details related to any Incidents or Injuries that occur at an SBP game, practice, event, or other league sanctioned activity. These details will be provided to our League Safety Director and League President, but will otherwise will be kept confidential. You can feel free to contact our Safety Director at safety@southbaypony.com if you have additional questions.

Date of Incident *

YYYY

Time of Incident

Time

Location of Incident *

Team *

Opposing Team (if applicable)

Description of the Incident *

Did an Injury occur as a result of the Incident? *

Yes

Please Provide Details of any Injury

Issues that lead up to the Incident

Specifically when, where, and how did the Incident occur?

Please list Specific Rule Violations that are being alleged (if applicable)

Please list all persons involved in the Incident *

Please list Witnesses to the Incident

Please provide any Steps the Manager has taken to Remedy the Situation.

Reporting Party Name *

Reporting Party Contact Information (cell phone or email) *

Additional Information you would like to Provide

Submit

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