Seizure Report Fields marked with an * are required This report is to be submitted immediately for every seizure. If the seizure results in an injury or activation of emergency services, do not complete this form. Contact the SEASPAR office immediately at 630.960.7600 and complete the Accident/Incident Report. To complete that form, save it to your computer, complete it using Adobe Reader, save the file, and attach it in an email to info@seaspar.org. Date of Seizure * Time of Seizure * Program * Department * Seasonal Programs EAGLES Inclusion SEASPAR Day Camp Program Location * Participant's Name * Parent Name * Parent Phone * What was the participant doing when the seizure began? * Where was the participant? Be specific. * How long did the seizure last? * What was done for the participant during/after the seizure? * Was the participant injured? If so, describe. * Were the participant's parents notified? * Yes No Person Who Notified Parents Parental Response Did the participant require medical attention? If so, by whom? * Did the participant remain at the program after the seizure? * Yes No If so, did he/she join in group activities? Yes No Witness 1 Name Witness 1 Relationship Witness 2 Name Witness 2 Relationship Name of Person Filing Report * Date * If you are a human seeing this field, please leave it empty. If you are a human, do not fill in this field.