Gymnastics BC - GymBC Injury and Accident Follow Up Form - Updated Nov 7, 2021

Gymnastics BC Injury and Accident Follow Up Form for Northern Territory MOU Clubs

Please complete this form with whatever relevant information you have to follow up on a previously completed Injury and Accident Report Form. If you need to discuss a potential or ongoing insurance claim, please contact Gymnastics BC by emailing Justin Schubert at safety@gymbc.org.

Who is completing this form?

You will receive a confirmation by email.

First name *

Last name *

Email *

Mobile

Whose injury/accident are you providing follow up information for?

First name *

Last name *

When did the injury/accident take place?

Northern Territory Member Club: *

Please provide a written description of new information relating to the injury/accident: *

Please provide a written description of new information relating to the injury/accident:

If you have video content to upload, please use this section:

If you wish to upload a photo or picture of a document, please use this section:

Electronic Signature*

Please sign your name inside the box

Type your name

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Electronic Signature Signature pad

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Connect to fill this form

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Email or mobile

Connection code

Waitlist

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Membership

Your membership is tied to your email address. If you are using the wrong email, your membership will not be detected. You can try disconnecting and connecting using another email address.

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