Injury Report FormPlease use this form to report any injury incident that takes place during official Cuala training or matches. Please note that this is for club records only and is independent of any other reports such as for Player Injury Funds. Submission of this form is subject to the Cuala Privacy Policy. Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Date of Incident (DD/MM/YY) *Location of Incident (eg. pitch name) *Name of Injured Person *Team/Age Group of Injured Person (eg. U14 Boys/Minor Girls) *Contact Number of Injured Person (parent/guardian contact number if U18) *Injury and Actions Taken Description of Incident that Caused Injury (Activity involved, What happened) *Description of Injury (Part of body, Nature of injury) * (Activity happened) Name Actions Taken (eg. Parent called, First aid administered, Ambulance called) *Names/contact details of people that assisted in any way: (Called ambulance, provided First Aid, called parents) *Any additional comments relevant to incident: (if injury happened in a match, did referee record it in match report - referee's name etc) *Reporting Person DetailsName of Person Reporting Incident *Position of Person Reporting Incident *CoachMentorFemale Liaison OfficerOtherContact Number of Person Reporting Incident *GDPR and Spam ProtectionGDPR Agreement *I consent to having this website store my submitted information so they can respond to my inquiry.Custom Captcha * = Submit