Intramural Injury Report

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First Name of official submitting the report*

Last name of official submitting this report*

Date and time of injury*

Injured individual's First name*

Injured individual's Last name*

Which sport were they playing*

What team were they on*

What is the nature of the injury, and how did it happen*

What action was taken by the intramural staff*

Did the player return to the game? Did they seek medical attention?*