All claims or incidents should be reported immediately to Risk Management Services, Inc., on the Report of Occurrence form. It is imperative that no person admits liability or responsibility or discusses any aspect of the incident with anyone other than an authorized Risk Management Services claims representative or Police official.

A Report of Occurrence form should be completed any time an injury occurs at a swimming function, whether or not it involves a program/ club member. Injuries involving spectators should also be reported. The form should be filled out by any club personnel responsible at the time of the incident; the parents of the injured participants should not be asked to complete the report form.

      Report of Occurrence Form (pdf)

Instructions:

1. Open the Report of Occurrence Form (pdf) in Adobe Acrobat Reader. (Download Adobe Acrobat Reader)

2. Fill out required information on the form and then utilize the "save as" function to save the form on your computer.

3. After you have saved the form you have the options to send the form to RMS via mail, fax, or email.

4. RMS Contact Information: Debbie Willams
dwillams@theriskpeople.com
Fax: 602.274.9138
P.O. Box 32712
Phoenix, AZ 85064-2712

If you have any questions regarding this sample waiver/ release form please contact RMS.

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