Wisconsin Youth Football League REPORT OF INJURY Player’s Name:_______________________________________________ Parent’s Name and Address: ____________________________________ ___________________________________________________________ Weight Division: __________________    Age:______    Grade:______ Where did injury occur?:   Practice[]      Game[]     Other[] Nature of Injury: _______________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ Action Taken: Emergency first aid []    Rescue squad []     Other []___________________ Parents notified:   Yes[]    No[] How did accident happen:________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ Recommendation to prevent similar accident:________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ Witnesses:____________________________________________________ Did player return to active participation in sports activity?:   Yes[]   No[] Reported by:_________________________   Program:_________________ Send copy to: Denny Davidson P.O. Box 114 Cottage Grove, WI 53527