Youth Armored Combat Injury Report – Ansteorra Youth Combat

This report is due within 48 hours of the Injury

Society Name *

First

Last

Legal Name *

First

Last

Membership Number *

Membership Expiration Date *

Background Check Expiration Date *

Background Checks are valid for 2 years after receipt of the Background Check Letter. If you are within 3 months of expiration please contact the Kingdom Youth Armored Combat Marshal.

Email *

Please use official Email Addresses when possible.

Sponsoring Branch *

Date injury occurred on *

Injury occurred during: *

Practice
Tournament
Other

Legal Name of injured party *

First

Last

Society Name of injured party *

First

Last

Nature of Injury *

Description of Incident *

Describe the cause *

How could this have been prevented? *

What actions have been taken? *

Branch Seneschal's Email *

Baron's Email

Baroness' Email

Regional Marshal's Email *

northern-youth@marshal.ansteorra.org, central-youth@marshal.ansteorra.org, southern-youth@marshal.ansteorra.org

Message