Skip to form

City of Concord
Parks and Recreation

lowrys@concordnc.gov

147 Academy Ave NW
Concord NC, 28025

704-920-5601

SeamlessDocs

Type_of_report
Incident Time AM or PM
Time Reported AM or PM
Who_was_involved_incident
Gender M or F
Incident_witnesed by Staff Y or N
Participant Refuse medical Attention Y or N
Was care provided by facility Staff Y or N
Was_EMS_personnel_called Yor N
Time_EMS_personnel_called AM or PM
Time_EMS_personnel_arrived AM or PM
Was_police_called_Y_or_No
Time_police_was_called_AM_or_PM
Time_police_arrived_AM_or_PM
Transported_to_emergency_facility
Person_returned_to_activity
Parents_contacted
Signature HereClick to Sign
03/16/2026Click to Sign
x

Additional Signatures Required