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