Injury Report Form

We understand that injuries can occur. Please fill out the information below and we will get back to you in 2-4 business days to discuss a path forward. MFA reserves the right to review the doctor’s note upon request.

Participant Name

First Name

Last Name

Parent/Guardian Name

First Name

Last Name

Description of Injury

Date of Injury

YYYY

Date of First Treatment or Doctor Assessment

YYYY

Expected Recovery Time

As provided by your doctor

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