This form is to be completed by a club official at the time of the injury and submitted to the Provincial Sport Organization at the end of the game.
Please complete and submit the information below in its entirety. You must be head or assistant coach/trainer/official/family member or player (18+) to submit this form. If you have any questions about the information required, please email Annie Goncin, Operations Coordinator for Ringette Ontario at injury@ontario-ringette.com prior to submitting your sport injury form. Please note that all employees of Ringette Ontario are subject to the Personal Information Protection and Electronics Document Act (https://ringetteontario.com/privacy-policy/).
Please indicate in the box below what caused the injury and whether it could have been avoided, i.e. equipment failure (make/model).
Please indicate where on the ice the incident occurred. Describe as best as possible.
Was Injured Party Wearing Protective Equipment?
Has the injured party filed an insurance claim?
i.e., Parent, Legal Guardian, Trainer, etc.
ALL INFORMATION COLLECTED ON THIS FORM OF A PERSONAL NATURE IS STRICTLY CONFIDENTAL AND WILL NOT BE DISCLOSED TO A THIRD PARTY.
Please forward completed form to Ontario Ringette Association by mail, email or fax as indicated above, within 7 DAYS of the injury occurrence.