Injury Reporting Form.
All injuries must be reported as soon as possible and before attending your next session.
This form must be completed by a parent/guardian if under the age of 18.
Once completed, please WhatsApp Emilie to notify her.

Question Title

1. Members full name

Question Title

2. Form completed by

Question Title

3. When and how did the injury occur?

Question Title

4. Type of injury

Sprain/Strain

Bruise/Cotusion

Fracture/Break

Dislocation

Muscle Tear

Other (please specify)

Question Title

5. Have you been seen by a medical professional?
If yes, please provide their diagnosis, guidance and rehab plan.

Question Title

6. Are you able to continue dancing?

Yes, with no restrictions

No, temporarily unable to dance

Yes, with modifications (explain below)

Question Title

7. I confirm that the above information is accurate to the best of my knowledge. I understand that this form is for injury documentation and communication purposes.

I confirm

Question Title

8. Date of completion

Date / Time

Date

Injury Reporting Form. All injuries must be reported as soon as possible and before attending your next session. This form must be completed by a parent/guardian if under the age of 18. Once completed, please WhatsApp Emilie to notify her.

Question Title

* 1. Members full name

Question Title

* 2. Form completed by

Question Title

* 3. When and how did the injury occur?

Question Title

* 4. Type of injury

Question Title

* 5. Have you been seen by a medical professional? If yes, please provide their diagnosis, guidance and rehab plan.

Question Title

* 6. Are you able to continue dancing?

Question Title

* 7. I confirm that the above information is accurate to the best of my knowledge. I understand that this form is for injury documentation and communication purposes.

Question Title

* 8. Date of completion

Injury Reporting Form.
All injuries must be reported as soon as possible and before attending your next session.
This form must be completed by a parent/guardian if under the age of 18.
Once completed, please WhatsApp Emilie to notify her.

1. Members full name

2. Form completed by

3. When and how did the injury occur?

4. Type of injury

5. Have you been seen by a medical professional?
If yes, please provide their diagnosis, guidance and rehab plan.

6. Are you able to continue dancing?

7. I confirm that the above information is accurate to the best of my knowledge. I understand that this form is for injury documentation and communication purposes.

8. Date of completion