| AFSA INJURY CLAUSE REQUEST |
| Along with this request, coaches must submit: |
| * a Dr's note explaining the injury and the amount of time off required |
| * the injury report from the competition |
| Today's Date: |
| Athlete's Name: |
| Injury Date: |
| Events Missed, please list the disciplines below: |
| EX: Jr. Nationals; Moguls, Air and Half Pipe |