Injury Form (Non-Marshal)

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.

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
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