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03 9998 6493
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About
2023 Info Pack
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Club History
Frequently Asked Questions
Programs & Classes
CheerKids – Recreational
CheerSport – Semi-competitive
All Star Novice – Beginners
All Star Elite – Experienced
All Star Worlds – Advanced
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Incident Report
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Incident Report
INCIDENT REPORT
"
*
" indicates required fields
Personal Details
Is this incident for an injury or something else?
*
Injury
Something Else
Follow Up (office use only)
Athlete Name
*
First
Last
Team / Class Attending
*
Person in Charge of Team / Class
*
Incident Details
Date of Incident
*
Day
Month
Year
Date of Follow Up
*
Day
Month
Year
Approximate Time of Incident
*
Hours
:
Minutes
AM
PM
AM/PM
Location
*
Skill
*
Athlete activity when incident occurred
Stunting - Basing
Stunting - Flying
Stunting - Back Basing
Tumbling
Jumps
Conditioning
Other
Description of Accident / Incident
*
Affected Body Areas
*
Nature of Injury + Signs & Symptoms:
*
First Aid Management
*
Did athlete return to training?
*
Yes
Yes (modified)
No
First Aider Name
*
First Aider Signature
*
Reset signature
Signature locked. Reset to sign again
Athlete Referred to:
*
Hospital
Ambulance
Doctor / Physio
Parent / Family
Other
Does this incident require a follow up?
*
Yes
No
Unsure
About
2023 Info Pack
Staff
Latest News
Videos & Media
Club History
Frequently Asked Questions
Programs & Classes
CheerKids – Recreational
CheerSport – Semi-competitive
All Star Novice – Beginners
All Star Elite – Experienced
All Star Worlds – Advanced
Casual Classes
Private Classes
School Holiday Program
Joining MCA
Book A Free Trial Class!
Enrolment Portal
Participant Waiver
Pro Shop
Contact Us
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