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Athlete Injury/Accident Report
Contact Information - COMPLETED BY
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* Indicates required question
First and Last Name:
*
Your answer
Email:
*
Your answer
Phone Number:
*
Your answer
INJURED PARTY
First and Last Name:
*
Your answer
Date of Injured
*
MM
/
DD
/
YYYY
DESCRIPTION
Nature and extent of injury:
*
Your answer
Exact Location:
Your answer
What was the person doing at the time of the accident?:
*
Your answer
What caused the injury?:
*
Your answer
Describe in detail how the accident occurred:
*
Your answer
What actions were taken in the field?:
*
Your answer
FOLLOW UP
What was the result of the follow-up with the family/player?:
Your answer
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