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Intramural Sports
IM Injury Report Form
IM – Injury Report
Sport:
*
Team Name:
*
Captain / Czar:
Phone:
Present?
Yes
No
Location:
Date:
MM slash DD slash YYYY
Reported by:
Name:
Home Phone:
Work Phone:
Residence:
Authorities Notified:
Yes
No
Date Reported
MM slash DD slash YYYY
Time Reported:
Treatment:
Where, How, and By Whom?
Victim Information:
Name:
Home Phone:
Work Phone:
Residence:
Details of Injury / Incident:
*
Witness Information:
Name:
Home Phone:
Work Phone:
Residence:
Comments
This field is for validation purposes and should be left unchanged.
Email
This field is for validation purposes and should be left unchanged.
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卓大师回收圈
博彩平台
博彩平台
欧洲杯买球入口
欧洲杯买球入口
第九阅读网
European-Cup-buying-feedback@yihetianquan.com
European-Cup-buying-admin@hr888888.com
European-Cup-buying-admin@hr888888.com
欧洲杯买球
Sports-betting-support@0313daikuan.com
在线博彩
Buy-ball-app-contactus@nongminshuhuayuan.com
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