CRUSA / FC Bucks - Injury Report
CRUSA/FC Bucks Coaches must report all injuries meeting the following requirements. Any time a player suffers an injury during practices, games or other team/league events that:
1) Prevents them returning to the field during the practice, game, or other team/league event in which the injury took place.  and/or
2) Results in the player seeking medical treatment/counsel subsequent to the injury occurring.

Please use this Injury Reporting Form within 48 hours of becoming aware of the incident.


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Your Name *
Your Phone Number
Your Relation to the player
Clear selection
Date of Injury
MM
/
DD
/
YYYY
Location Injury Occurred
Name of Injured Player
Team Gender
Clear selection
Team Age Group:  (Year of Play)
CRUSA/FC Bucks Team Name
Team Coach(es) in attendance
Briefly Describe Injury
Briefly describe how the injury occurred
Did the injured player receive treatment at the time of the injury
Clear selection
If Yes, please describe
Did the injured player receive treatment after the injury occurred
Clear selection
If Yes, please describe
Name, Phone,  and Email address of parent/guardian of injured player *
Thank you!
This form will be sent directly to the Risk Management Director.

If you have any questions they can be reached at crusainjuries@gmail.com


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