Injury Report (Wainfleet Minor Hockey)

Print Injury Report
Teams are to complete this submission to WMHA should any injury occur (serious or not) at a WMHA game, practice or event. This is NOT the official Hockey Canada Injury Report that needs to be completed. This is an internal notification of injury only.
Injury Information
Please provide the information to the WMHA regarding what injury happened, where, when and to whom in this brief submission section.
  1. What city or arena did the injury incident take place in?
  2. Please provide if this information is known at the time of completing this form. This would specifically refer to what happened at the rink. Example answers: player sent to hospital, player went home with parent, player will seek medical followup, player was bandaged and continued to play, coach that was injured has to leave the ice and rest in the dressing room
Who is completing the form?
Please provide the name of the individual who is completing and submitting this form.
Human Validation
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Printed from on Thursday, May 19, 2022 at 2:00 PM