Skip to content
HOME
ABOUT
About Us
Program Resume
Board of Directors
Advisors
Operations
Why We #PlayforKate
Sports Performance Specialist
Our Facilities
TEAMS
NATIONAL
18U National Unruh/Greenwood
16U National Unruh/Greenwood
14U National Unruh/Hobgood
PREMIER
18U Premier Gibson
18U Premier Glass
16U Premier Clark
16U Premier Roark
14U (10) Premier Oster
14U (11) Premier Herald/Becker
14U (11) Premier Jansen
EVANSVILLE
16U Long-IN
14U (10) Schoonover-IN
14U (11) Jones-IN
ILLINOIS
16U Keepes-IL
KENTUCKY
14U (11) Bynum-KY
12U (12) Davis-KY
12U (12) Scott-KY
12U (13) McGohon-KY
10U (14) Haley-KY
10U (14) Medley-KY
SOUTHERN INDIANA
18U Williams-IN
16U Hegedus-IN
12U (12) Kilbride/Henderson-IN
12U (13) McAfee-IN
10U (14) Brammer-IN
10U (15) Kilbride-IN
8U (16) Weaver-IN
TENNESSEE
12U (12) Prock-TN
MEMBERS
PLAYER REGISTRATION
COACH REGISTRATION
PAYMENT
UA UNIFORM CARE INSTRUCTIONS
FORMS
INCIDENT REPORT
RETURN TO PLAY
WAIVER-GENERAL
WAIVER-SUB
HEADS UP CDC Concussion Program
FANWEAR
CONTACT
CONTACT
NEW PLAYER INQUIRY
NEW COACH/TEAM INQUIRY
DONATION
INCIDENT REPORT
christy conrad
2023-05-25T10:41:19-04:00
INCIDENT REPORT
Report must be complete and submitted within 24 hours of the incident.
Step
1
of
4
25%
Date of the Incident
*
MM slash DD slash YYYY
Time of the Incident
*
:
Hours
Minutes
AM
PM
AM/PM
Reason for report
*
Injury
Conduct
Other
Sport
*
Baseball
Softball
Person Incident Report Issued On
*
First
Last
IFE Team or Organization person represents
*
Select
8U 11 Jansen
10U 10 Oster
10U 10 Scott
10U 09 Hegedus
10U 09 Herald
10U 09 Richey
12U 08 Tucker
12U 07 Teeter
14U 06 Premier Drummond
14U 06 Gibson
14U 05 Premier Apple
14U 05 Premier Franks
16U 04 Premier Marx
16U 04 Mayes
16U 04 Premier Unruh
16U 03 Premier Chumbley
16U 03 Grimes
18U Premier Pinkston
Cox/Shirebaseball
Other(specify below)
Other
Specify what organization the person represents if other than IFE.
Position
*
Player
Coach
Official
Spectator
Male/Female
*
Male
Female
Age
*
Please enter a number from
1
to
100
.
Event Type
*
Practice
Game
Other
Event Location
*
Player's Address
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Parent/Legal Guardian Name
First
Last
Parent/Legal Guardian Address (if different from player)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Coach Name
First
Last
Description of event being reported
*
Who responded to the incident?
*
Select
Coach
Player(s)
Parent(s)
Official(s)
Athletic Trainer
Security
Paramedics
Police
Was First Aid treatment provided?
*
Yes
No
If yes, who provided First Aid treatment?
First
Last
Was medical treatment beyond First Aid treatment provided?
*
Yes
No
If yes, where and who was the treating physician?
Treating physician
First
Last
Describe the care provided
Was a parent/legal guardian contacted?
*
Yes
No
Attempted but unable to reach
Person Contacted
First
Last
Witnesses
Name and phone number
Verification Statement
*
Verification Statement
I verify that this report is true and correct to the best of my knowledge.
Signature of person completing this incident report.
*
Typing my name below is my electronic signature, I verify that this report is true and correct to the best of my knowledge.
First
Last
Email
*
Date
*
MM slash DD slash YYYY
Δ
Page load link
Go to Top