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G.B.M.S.L. Injury Report

This form should be filled out by coaches, umpires and parents to inform the league of "any and all" accidents & injuries that are incurred during all G.B.M.S.L. activities

We encourage you to submit this form immediately following an incident while the details are fresh in your mind.
If there is going to be an accident insurance claim (such as dental) then the form must be submitted to our insurance carrier
within a few days of the incident.

The form will be automatically forwarded to Christine Patenaude, our current Insurance Liaison for the league as well as to the person submitting provided an e-mail address is provided.

Injured Persons Information:


Submitter Information:


Incident Information: