Sherwood Dance Academy Incident ReportComplete form in full Name of person completing form * First Name Last Name Name of Class/ Event and Location * Date of Accident * MM DD YYYY Time of Accident * Hour Minute Second AM PM Name and Age of Injured * Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Phone * (###) ### #### If minor, were parents notified: * Yes No If minor, were parents present: * Yes No Event taking place at time of accident: * Name of person notified and relationship: * Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### How did accident occur? * Description of injury: * Type of aid given and administered by: * Was injured person taken to hospital? * Yes No If yes, what hospital? * If injured person was not taken to hospital, what action was taken? * # of coaches/instructors in attendance: * Approximate attendance in class/event: * Name of person causing incident, if applicable: * Use this space if additional information is required: Witnesses Name First Name Last Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Relationship Comments Name First Name Last Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Relationship Comments: Thank you!
