LNYSA Accident Report Form
If you are a registered LNYSA Coach or Ref and involved in an accident during a sanctioned LNYSA game/practice/event please report the incident within 24hrs by completing this form
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Email *
Name of Person completing the form *
Your Role *
Your Email address *
Injured Person Name *
Injured Person Shirt Number
What Is This Player
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Coaches Name
Team Name
Injured Person gender
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Injured Person Age group
Type of Activity
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Time, Date & Location of Injury *
Nature of Injury *
Paramedics Called
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Other Supporting Information
A copy of your responses will be emailed to the address you provided.
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