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Get Dance Studio Insurance Injury/Incident Report

Name of instructor supervising class: Describe Injury and how it occurred: Was student able to continue class? Type of injury: Yes No Abrasion/Scrape Bruise Burn Concussion/Head Injury Cut/Laceration/Puncture Hernia Sprain/strain Other What Treatment was given: How & when were Parents Notified: Form Provided By: Dance Protect Plus www.DanceStudioInsurance.ca 1 STUDIO NAME: __________________________________________________________ INJURY / INCIDENT REPORT Follow-UP: Within 24 hours D.

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