Injury Report
Axemen Lacrosse
Name
*
First Name
Last Name
Date of Injury
*
Team
*
Age Group
*
Location of injury
*
Facility name
Summary of Injury
Parent / Guardian
*
First Name
Last Name
Parent /Guardian Contact Phone
*
-
Area Code
Phone Number
Type of Injury
Bruising
Sprain
Fracture
Laceration
Concussion
Other
Area of Body
Head
Neck
Shoulder
Upper Arm
Lower Arm
Elbow
Wrist
Finger
Chest
Stomach
Hip
Upper Leg
Lower Leg
Knee
Ankle
Foot
Toe
Back
Other
Amount of Playing Time Lost
1 Shift
Multiple Shifts
1 period
Multiple Periods
1 Game
Multiple Games
Your Name
First Name
Last Name
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Your Role
Manager
Trainer
Coach
Assistant Coach
Player
Parent
Submit
Should be Empty: