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Injury
Disciplinary
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16U
12U
14U
10U
8U
18U
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1
2
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N/A
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Player
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I certify the information provided in this incident report is true, and accurate to the best of my ability.
I understand that this incident will be investigated by the TBJL Board of Directors, and possibly a disciplinary committee.
I authorize the investigating officer to contact me if any additional information is needed.
I do not wish to be contacted regarding this incident.
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Date of Incident
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Time of Incident
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What Rink did this incident take place?
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Name of Player
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Injury or Disciplinary (select one)
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Age Group of Player
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Summary of Incident
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Your Team Name
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Opposing Team Name
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Final Score of Game (your score, then their score)
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What period did this incident take place
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Player
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E-mail address of person reporting incident
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I certify the information provided in this incident report is true, and accurate to the best of my ability.
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