Complete this form whenever an injury or incident occurs at the academy. All fields marked * are required.

Incident Overview

Academy *

Date of Incident *

Approximate Time *

Class Segment

Location *

Person(s) Involved *

Parent Name (if applicable)

Reporting Person's Name *

Reporting Person's Email

Used for follow-up notifications

Witnesses

Anyone who could provide an account of what happened

Description of what happened *

Injury & Response

Were there any injuries? *

Was first aid given? *

911 / EMS contacted?

Parent / guardian notified?

Follow-up

Follow-up required

Check this if someone needs to act after this report — e.g. bullying, an altercation, or any non-injury incident that needs handling. Automatically required when there's an injury or first aid.

Reporting Person's Signature *

Signature Date *

Incident Overview

Injury & Response

Follow-up

Prosper

West FRISCO

Melissa

McKinney

CELINA

ALLEN