TELL US ABOUT YOUR FALL

written



First name *
Age when it happened *
Place *
Time of day *
 Alone 
 In company 
What you were doing when you fell *
Image associée à la chute * see examples here
If no image corresponds to your fall, describe it in 2 lines


Circumstances that led to the fall
Description of the fall
Your state of mind after the fall
*
Attach a picture of yourself
Attach a video
(if applicable)


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