GBC KIDS Incident/Injury Report

This report should be filled out within 12 hours of the incident/accident.

You may be contacted for further information or clarification. You will also be asked to sign a copy of the form for our records.

Your Information

Injured Child

Date

(if a minor)

Details of the incident

Witnesses

Please include their phone number if known.

If another child was involved

in the incident, please list:

(if a minor)

(if known)

Injuries

Please describe.