Injury Report Form
*** If player or cheerleader was taken to the hospital or doctor a note is required to return to cheer or football practice.*** Football note needs to say clear to play TACKLE football or cleared for Cheer leading with no restrictions.
Date:
-
Month
-
Day
Year
Date
Time:
Hour Minutes
AM
PM
AM/PM Option
AM/PM
AM
PM
Check all that apply:
Football Divisions
6U
8U
9U
10U
11U
12U
13U
5/6
7/8
8/9
9/10
10/11
11/12
12/13
Challenger
Cheer Divisions
Cheer Divisions
TM
MM
JPW
JV
5/6
7/8/9
10/11
12/13
Athlete's Name:
Parent(s) Name:
Contact Email:
example@example.com
Contact Phone:
Format: (000) 000-0000.
Type of Injury:
Anatomical area injured:
Type of Injury:
Extent of Injury:
Was Emergency or 911 called?
Yes
No
Was First Aid administered?
Yes
No
Name of person administering First Aid:
Other Treatment:
Follow up:
Name of person completing report:
Head Coach:
Signature:
COMPLETE AND SUBMIT
HEAD COACH SIGNATURE REQUIRED
Preview PDF
Submit
Should be Empty: