Injury Report Form

If you have injured yourself please fill out the below form and click SUBMIT within 48 hours of your injury.

If you do wish to proceed with a claim please visit NSW Futsal website – CLICK HERE to do so

Match Information

Help us to identify the match in which the injury occurred.

Date of Incident

Select the date of the match.

Competition

Enter the name/grade of the competition. For a list of current competitions, Click here

Venue

Enter the name of the venue. For a list of current venues Click here

Administrator's name

Enter the name of the NBFA administrator on duty the night of the injury. Optional.

Describe the nature of the injury and the action taken.

Player Name

Enter the name of the player. Required.

Player Date of Birth

Day

Month

Year

For example, 27 03 2008

Team Name

Enter your team name.

Injury Details

Please provide as much information about the injury as possible.

Please provide your contact information.

Your name

Please enter your name.

Your email

Enter your email so we can get in touch

Your contact tel

Enter a mobile or landline.

Once you have finished completing the form, press the submit button below.
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