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I give or have obtained consent for the storage of these injury records.
Your contact details
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Basic information
Injured person
Name*
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Age at the time of injury*
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Unknown
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Details
Date*
Time*
Venue*
Please select...
Auckland Viaduct
Lake Pupuke, Takapuna
Milford Beach
North Shore Canoe Club
Ponsonby Community Centre - Johnny Mitchell Room
Promenade Point - Kai Iwi Camping Ground
Takapuna Rugby Club
TBC - Central location
Westhaven Marina - Z Pier
Whatever Building
How did the injury occur*
Please select...
Collision with fixed object
Collision with other person
Fall/stumble
Jumping
Landing from jump
Overexertion
Overuse
Slip/trip
Struck by ball (e.g. dislocated finger)
Struck by other player
Struck by playing equipment
Temperature-related (e.g. heat stress)
Twisting to pass or accelerate
Other
Description*
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