GRJFA Injury Report
Name of Injured *
Your answer
Date of Injury: *
MM
/
DD
/
YYYY
Time
:
Location where injury occurred: *
Your answer
Name of Person Reporting the Injury: *
Your answer
Relation to injured: *
Your answer
Email address: *
Your answer
Phone number:
Your answer
Description of injury: *
Your answer
Describe how injury occurred: *
Your answer
Did injured receive medical treatment? *
If yes, enter Date of Treatment:
MM
/
DD
/
YYYY
If yes, list hospital/doctor visited:
Your answer
If yes, will the injured player be required to sit out from sports activities? *Please note, if yes, before returning to participate in a GRJFA program, a Doctor’s note releasing him/her to participate must be submitted to a GRJFA representative.
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