Inwood Athletics Injury Report

Inwood Athletics Injury Report

Please complete the following form with as much detail as possible, in regards to Student-Athlete Injury.
Staff Email*
example@example.com
Name of Person Submitting Report

First NameLast Name
Title
Phone Number of Person Submitting Report
Please enter a valid phone number.Format: (000) 000-0000.
Middle SchoolHigh School
Sport
Student Name

First NameLast Name
Injury Date

MonthDayYear
Date
Hour MinutesAM/PM Option
ClassroomFieldGymLocker RoomOther
GamePracticeTransportationOther
Please list any witnesses
Body Part Injured (Select all that apply)
Describe 'Other'
Type of Injury (Select all that apply)
Describe 'Other'
YesNoNot Sure
First Aid Given (Select all that apply)
Describe 'Other'
Parent Took HomeReturned to SportTransfer to HospitalParent took to ERParent took to DoctorCalled 911Other
Please describe the specifics of how the injury occurred.
Parent Name and Number
Time Parent was Notified

Hour Minutes

AM/PM Option
Should be Empty: