ACA Incident/Accident Communication Record

Name of Staff Member Submitting Communication Log

First

Last
Name of Camper/Person Involved in Incident*

First

Last
Date of Incident*

Month

Day

Year
Please outline communication with the parents regarding this incident. Report the date, time, and form of communication (email, phone, etc.) as well as the name of the parent contacted.
Outline of communication for incident/accident:
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