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Accident Form
Name of person reporting the accident
Date of accident
Injured childs name
Time Of accident
Age group of child
Where did the accident occur?
How did the accident occur?
Give a description of the injury?
Was first aid provided?
Yes
No
Who provided the first aid?
Please detail any first aid provided
Was the parent or guardian in attendance when injury occured?
Yes
No
Was the parent or guardian made aware of the accident?
Yes
No
Submit Form
Your form has been submitted
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