Capital District Board of Women's Soccer Officials

Liability Alert Form

Fill out an individual form for each event. After you submit, you will be returned to the form with the fields still filled in, so if you have "one of those games," it will take less time to submit all your injury-related information.

* denotes required field

Player

Player's name *

School *

Game

Where

School where accident occurred*

Number Present *

Who

Home team *

Opponent *

When

Game date * format: mm/dd/yyyy

Time: :

Accident

Description of accident

Was the injured disobeying a rule or regulation in force at the time of the accident?

Was the injured negligent?

If negligent, in what way?

Supervisor in charge of the team

Probable nature of injury

Nature of injury determined by

Names of adults who saw accident

What was done for the injured?

Remarks

Officials

Official *

Partner * Enter "Alone" if officiating without a partner

Your email Will email you this form if you enter your email