Injury Report Form 2025/26
This form is to enable individuals injuries that occur in Lacrosse environments whether training, matches or events/tournaments. Additional fields will appear as relevant as you progress and input information. If an injury occurred as the result of an on-field rule violation, please ensure the on-field and off-field incident report form 2025/26 is submitted. If you have any problems using the form or enquires as to the personal injury insurance claims as per your England Lacrosse Individual Membership please email k.worthington@englandlacrosse.co.uk
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
-
Which of the following best describes you in relation to the injury?
Please Select
Injured Party
Official
Coach
Parent
Spectator
Club Official
Event Organiser
Other
Injured Party Name
First Name
Last Name
Injured Party Email if known
example@example.com
Which of the following best describes the situation where the injury occurred?
*
Training
League Match
Friendly Match
Domestic Event/Tournament
Overseas Event/Tournament
Event/Tournament Name
Please provide the date the injured occurred?
-
Month
-
Day
Year
Date
Please provide an approximate indication of the time the injury occurred?
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
Geographical Location where the injury occurred?
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Team
*
Enter Home Team name
Away Team
*
Enter Away Team name
Head/ Lead Official
*
Enter Head/Lead Officials Name
Second Official's Name
*
Please give as many details of the injury as possible including a description of the activity, the playing surface, whether any medical intervention provided at the time or since, whether medical diagnostics has occurred or due to occur
*
Submit
Should be Empty: