Kickboxing Ontario

K I C K B O X I N G

CONCUSSION DATA COLLECTION

EMail Us
info@wakocanada.org
Call Us
+905.681.9815

Kickboxing Ontario

Report Your Concussion

The objective of the Project is to collect specified concussion-incidence data at the field of play to assist in quantifying the incidence of sport-related concussions in Ontario and track the impact of concussion safety measures put in place through Rowan’s Law (Concussion Safety), 2018.

Please fill in all that apply to your situation

Athlete Age:

Gender

Discipline:

Date of Injury:

Injury Location:

Mechanism:

Competition Type:

Bout Details:

Bracket Details:

Tournament Details:

Training Details:

Medical Confirmation:

Date of Confirmation (if available):

Date of Clearance (if available):

Days of Symptoms:

To prevent spam please answer the math question:

By opting into the web form above you are providing the Government Of Ontario with important concussion information. All information is private and will only be used for concussion data reports only. No identifying data is collected.

CONCUSSION DATA COLLECTION

EMail Us

Call Us

Kickboxing Ontario

Report Your Concussion