Altius Incident/Injury Report form
To be used by parent or guardian reporting an injury from home.
Email address *
Student name: *
Your answer
Parent name *
Your answer
Phone number: *
Your answer
Today's date: *
MM
/
DD
/
YYYY
Date of injury: *
MM
/
DD
/
YYYY
Description of injury *
Your answer
Best time of day for Altius to contact you: *
Your answer
Submit
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