Injury Incident Form

THIS FORM IS FOR REFEREES ONLY.

FOR PLAYERS, PLEASE DOWNLOAD AND COMPLETE THE INJURY CLAIM FORM UNDER “DOWNLOADABLE FORMS”

 

For any injuries that occur during a league game, please fill out the following form:

 

Your Name (required)

Your Email (required)

Name of person injured (required)

Date/Time of Game (required)

Location of Game (required)

Nature and extent of injuries (required)

Full description and cause (required) *Include the equipment that the injured player was wearing as it relates to the area of the injury

For more severe incidents, Names of Witnesses (incl phone number if possible)