GMSA Player Incident Report (Guelph Minor Softball Association)

GMSA Player Incident Report

In the event of an incident where a player is injured and requires medical attention, please complete this report in full within 48 hours of the incident.

Player Information

Player Name:^*

Player Home Address:

(if available)

House League Division^*

Pick your Division from the list

Team Name or Number^*

Parent / Guardian Information

A copy of this report will be sent to the coach and the parent / guardian upon submission

Parent / Guardian Name:^*

Parent / Guardian Phone #^*

Example: ###-###-####

Parent / Guardian email address^*

A copy of the report will be sent to this address

Coach Name^*

Coach email address^*

A copy of the report will be sent to this address

Incident / Accident Information

Provide as much detail as possible

Please indicate the date and time of the incident:^*

Location^*

Describe how the accident happened^*

Be as specific as possible

Suspected Injury^*

Be as specific as possible

Suspected Concussion?^*

YesNo

If a concussion is suspected additional forms must be completed. Please email [email protected] to obtain copies of the forms.