Accident Report

An Accident Report should be completed for any incident resulting in injury (whether minor or major) occurring on the property of Saint Elizabeth Ann Seton Catholic Church or any offsite activity that is sponsored by Saint Elizabeth Ann Seton Catholic Church. This report should be completed within 24 hours of the incident.

If you have any questions, please contact the Business Manager, Jennifer Engquist, in the parish office.
The maximum number of form submissions has been reached. This form is currently not available.
- Information About Person Reporting Accident
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Phone Number REQUIRED Please fill out this field. Please enter a phone number.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Information About Person Injured
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Age Adult Minor (Under the age of 18)
  
  Brief description of injury
Submit