Please type the Player's Name

Please type the Players ID number

Please type the Team name

Please type the Ground

Please Enter the Date and time of incident

Please describe the incident

Was medical assistance required

Please type who gave the medical assistance

Was an ambulance called?

Is an insurance form required?

Witness 1 name and contact details

Witness 2 name and contact details

Your name and contact details

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Football NSW Insurance Website
As a registered player of GlenhavenFC you are covered under the Football NSW Insurance Package.

In addition to submitting your Incident/Injury Report to us, you are also required to submit a claim directly with FNSW. Please visit the links below which will assist in your online claim.

Football NSW Insurance Website

Online Claims

Important Documents

Serious Injury Report (pdf)

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