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P.O. Box 979 Valley Forge, PA 19482 610.933.0800 Fax: 610.935.2860 claims agadm.com www.agadministrators.com Student Accident Claim Form Capitol Region Education Council Please complete and submit
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The student accident claim form is a document used to report an accident or injury that occurred to a student.
Parents, guardians, school staff, or any party involved in the accident or injury is required to file the student accident claim form.
To fill out the student accident claim form, provide details of the accident or injury, student's information, witness information, and any other relevant information.
The purpose of the student accident claim form is to document and report any accidents or injuries that occur to students while under the care of the school.
Information such as student's name, age, school, date and time of accident, location of accident, description of injury, and any witnesses involved must be reported on the student accident claim form.
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