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Mackay Hockey Association Injury Registry
The purpose of this form is to capture information regarding injuries within Mackay Hockey Association.

You are about to enter personal information into a form by Mackay Hockey Association (MHA).

MHA respects the privacy of individuals about whom we collect personal information. The personal information that MHA collects from you via this form is collected for the purpose of capturing information regarding injuries in hockey. please contact us to access and correct your details or make a complaint.
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ATHLETE INFORMATION
Name *
Gender *
Date of Birth *
MM
/
DD
/
YYYY
Club Name *
Current Registered Grade *
Pre-existing Medical Conditions *
INCIDENT DETAILS
Date and Time of Injury *
Place of Incident *
Describe how the injury was sustained
Was the injury reported? *
Was any treatment provided? *
Player Confirmation
By submitting this form you are agreeing that the information you have provided is true and correct at the time of you pressing submit.
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