| Type of Incident: | Injury |
| Match Number: | 9614 |
| Date of Incident: | 2021-11-12 |
| Time of Incident: | 07:35:00 |
| Location of Incident: | ECONOME PARK - FOLSOM, CA |
| Competition: | 2021_SOR_FALL_ |
| Home Team: | FOLSOM LAKE SURF |
| Visiting Team: | BLACKHAWKS SC |
| Age Group and Gender: | U16B |
| Team Affiliation of Individual Committing Incident: | FOLSOM LAKE SURF |
| Incident Summary: | Injury Report |
| Comments: | Injury Report - No action taken. |
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