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Student Injury Report
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* Indicates required question
Student Name
*
Your answer
Parent name
*
Your answer
Parent Email Address
*
Your answer
Parent Phone Number
*
Your answer
Brief Description of Injury
*
Your answer
When will the student return to school?
*
MM
/
DD
/
YYYY
Length of Injury (if known)
Your answer
List of Upstairs Classrooms and Blocks
*
Your answer
Any additional information you would like us to know?
Your answer
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