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Get Aquatic Management Accident/Report Form

______________ Injured Person/Victim: ___________________________________ Address: ________________________________________________________ City: ________________ Zip: _________ Phone No. _________________ Age: ______ Male/Female: _____ Lifeguard on Duty:_________________ Name of Family Member Notified: ____________________________ Relationship to Victim: ____________________ Phone No. ________________ Weather Conditions: Air Temperature: ___________ Water Temperature: ___________ Visibility: .

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