Form – Incident Report – Westgate Cabana Club

Incident Report

Date(Required)

Time(Required)

Location of the Incident(Required)

Shallow End, Deep End, etc.

Primary Rescuer(Required)

First Last

Staff

Secondary Rescuer

First Last

Staff

Secondary Rescuer

First Last

Staff

Person Involved/Injured(Required)

First Last

Member Type(Required)

Phone(Required)

First Aid Required(Required)

Yes

Age(Required)

Please enter a number from 0 to 100.

If under 18, Guardian Name

First Last

Contact Email

Witness Name

First Last

Phone

Witness Name

First Last

Phone

Description of Incident(Required)

Description of Incident

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