ICSHL Injury Form

ICSHL Injury Form

REQUEST FOR MINIMUM GAME PARTICIPATION EXEMPTION DUE TO INJURY
This form shall be submitted by the ICSHL Association representing this player. You must also include a written release from the player's doctor on their letterhead, indicating the date released. Without this release from the doctor, an exemption cannot be considered. Submit this form and any documents. They will be ruled upon by Al Danish, ICSHL Commissioner.

Requests must be received by February 10, 2027.
Players Name*

First NameLast Name
Grade Level*
Team Name*
Level*

VarsityJVGirls Varsity
Nature of Injury*
Date of Injury/Illness*

MonthDayYear
Date
Unable to Play From*

MonthDayYear
Date
Unable to Play Until*

MonthDayYear
Date
Date Released/Cleared to Play*

MonthDayYear
Date
Number of Games Played*
Number of Games Missed*
Physician's Name*

First NameLast Name
Submitted by*

First NameLast Name
Date Submitted*

MonthDayYear
Date
Title (President, Head Coach, etc.)*
Submitter's Email*
example@example.com
Doctor's Release/Clearance Note*

Cancelof
Should be Empty: