Injury Form

Please fill in this form to submit a report. If you have any issues, please take a screenshot and email it to the Kingdom Webminister at webminister@aethelmearc.org.

Martial Activity

This will route the report to the correct Martial Deputy in addition to the Kingdom Earl Marshal and Kingdom Seneschal
Region Where Injury Took Place

Region Where Injury Took Place Region 1 Region 2 Region 3 Region 4 Region 5
Group Where Injury Took Place
Date of Injury Date of Injury / MM / DD YYYY
Your SCA Name
Your Modern Name
Your Mailing Address Your Mailing Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Your Phone Number Your Phone Number - ### - ### ####
Your Email
Event Name
Event Address Event Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Chirurgeon's SCA Name
Chirurgeon's Modern Name
Injured Party's SCA Name
Injured Party's Modern Name
Injured Party's Address Injured Party's Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Injured Party's Phone Number Injured Party's Phone Number - ### - ### ####
Injured Party's Email
Complete Description Of The Incident. Please describe the Injuries and the outcome of the injuries, if known done at hospital.

4 stitches, cool compress and aspirin, etc
Injured Party Sent To The Hospital:

Injured Party Sent To The Hospital: Yes No