Inwood Athletics Injury Report
Please complete the following form with as much detail as possible, in regards to Student-Athlete Injury.
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Email *
Student Last Name *
Student First Name *
Full Name and Title of Person Submitting Report *
Phone Number of Person Submitting Report *
Which School *
Injury Date *
MM
/
DD
/
YYYY
Time of Injury *
Time
:
Location of Incident *
Required
Injury Occurred During *
Describe location and occurance if selected other
Body Part Injured *
Required
Describe injured area if selected other
Sport *
Type of Injury *
Required
Describe type of injury if selected other
If Suspected Concussion does the Athlete have a Pre-Concussion test on file? *
First Aid Given *
Required
Describe first-aid given
Any Witnesses? Names? *
Action Taken *
Required
Please Describe the Specifics of how the Injury Occurred. *
Parent Name and Number *
Time Parent was Notified *
Time
:
A copy of your responses will be emailed to the address you provided.
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