Injury Report Form
Please let us know about any injuries that occur in/out of the classroom, so that staff is aware and can monitor that dancer in class. Dancer's who are injured and still coming to class should still come in uniform attire, if possible. There are modifications that can be made so even injured dancers can take part in portions of class. Injured Dancer's should also bring their ballet notebook to class with them.
Dancer's Name *
Your answer
Today's Date *
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Name of Person Filling out this Report? *
Your answer
Email *
Your answer
Where did the injury take place? *
When did the injury take place? *
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Type of Injury *
Where is the injury (be specific)? *
Your answer
Describe the Injury (be specific) and how it occurred. *
Your answer
Did you recieve treatment? If so, what treatment/care did you recieve? *
Your answer
Do you need follow up care? *
If yes, please describe the care plan to date.
Your answer
Does your dancer have a doctors note with restrictions? *
If yes, please tell us the restrictions as well as the length of time these restrictions will be in place.
Your answer
Please keep us up to date with doctor's notes and progress reports so we can better help the recovery process. Remember, when an injury occurs there is a mental, emotion piece of an injury that also may need to be tended to depending on the severity. Please feel free to continuously update this form to keep us in the loop.
Your answer
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