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Aquatic Center Incident Report

  1. Cedar City Aquatic Center
    Incident Report
  2. Is victim a minor*
  3. Was guardian contacted:
  4. Did victim refuse care:*
  5. Was EMS called:
  6. Did you turn in Victim Information and Refusal of Care Form?
  7. Signature:
  8. Leave This Blank:

  9. This field is not part of the form submission.