Trampoline Park Injury Compensation Claim Form
Use this form to submit a compensation claim for an injury sustained at the trampoline park. Please provide accurate details about yourself, the incident, and your compensation request.
Full Name
*
First Name
Last Name
Contact Email Address
*
example@example.com
Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Date and Time of Incident
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Location of Incident (Area within the park)
*
Please Select
Main Jump Area
Foam Pit
Dodgeball Court
Basketball Hoops
Kids Area
Other (please specify below)
Brief Description of the Incident
*
Describe the Injury Sustained
*
Were there any witnesses?
*
Yes
No
If yes, please provide witness name(s) and contact details
Last 4 Digits of Government-issued ID (for claim verification)
Requested Compensation Amount (USD)
*
Submit Claim
Should be Empty: