Online Injury Reporting (West Niagara Minor Hockey)

Online Injury Reporting

Name of Person Injured^*

WNMHA Team ^*

Where Did The Injury Occur (arena)^*

What Date Did The Injury Occur^*

What immediate action was taken if any?^*

Team Event in which the injury occured^*

Was a Hockey Canada Injury Report Completed?^*

YESNO

Did the player return to action after the injury?^*

YESNO

Person Completing This Form^*

Position on the team^*

Email Address of person completing this form^*