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Home
About
Our Team
Mission and Vision
Programs
Day at the Beach
Wounded Warrior
Adaptive Surfing Clinic Program
Adaptive Swim Clinic Program
Canoe Day Program
Fitness Videos
Talk Story Tuesday Videos
Media
Sponsors
Testimonials
2022 Annual Report
Survey Results
Get Involved
Donate
Online Training Manual
Participant
Volunteer
Events
Upcoming Events
Events Calendar
Hawai’i Adaptive Surfing Championships
Program Photos & Videos
News
Contact
Map
Donate
Shop
Injury and Incident Report Form
Injury and Incident Report
Your Email
*
Date
*
Time
*
12
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00
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AM
PM
Location
*
Injured Person's Name
*
Injured Person's Contact Info
Injured Person's Age
AccesSurf Staff / Volunteers Involved
*
Staff/Volunteer Contact Info
Lifeguard/Professional Staff Involved
Lifeguard/Professional Staff Contact Info
Does Injury Require Hospital/Physician?
*
Yes
No
Hospital Name and Contact Information
Injury Description and First Aid Received
*
If you are human, leave this field blank.
Submit
