GTHLA Critical Injury Reporting Form
Use this form to report an injury of a severe nature, suffered during a GTHLA game.
Name of Injured Individual *
Your answer
Name of Individual Reporting Injury (you) *
Your answer
Date of Incident *
MM
/
DD
/
YYYY
Date Reported *
MM
/
DD
/
YYYY
Teams Involved in the Incident *
Your answer
Players Involved in the Incident *
Your answer
Arena Where Incident Took Place *
Referees Present for Game Where Incident Ocurred *
Your answer
Description of Injury *
Your answer
League Insurance Required? *
Submit
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