FEEDBACK OR COMPLAINT SUBMISSION FORM

FEEDBACK OR COMPLAINT SUBMISSION FORM
This form is for submitting feedback or a complaint for formal resolution to Kalamunda & Districts Basketball Association. Only matters that relate to, or occurred at, KDBA Domestic, WABL, NBL1, and other related programs are applicable.

This form will be submitted to the KDBA who will be in contact with you as soon as possible.
Contact Information
Name:*

First NameLast Name
Title:*
Phone Number:*
Please enter a valid phone number.
Email:*
example@example.com
Are you submitting feedback or complaint on behalf of someone else? If you are submitting a complaint on behalf of someone else, please provide their contact details below;
Name:

First NameLast Name
Phone Number:
Please enter a valid phone number.
Email:
example@example.com
Witness Information (if applicable):

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Please select what category your feedback or complaint is regarding:*
Other (please specify):
Date when alleged issue occurred

MonthDayYear
Date
Please detail what your complaint or feedback is:*
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What outcome are you seeking?*
Other (please specify):
Declaration
In submitting this complaint, I confirm that:*

The information I have provided on this form is correct to the best of my knowledge;I intend to cooperate in good faith, act in accordance with the BWA Code of Ethics and Code of Conduct, respect confidentiality of the process and immediately disclose any actual, perceived or potential conflict of interest to the Responsible Officer for the complaint as part of my involvement in the complaint process; andI understand that the information I provide will be treated confidentially and will not be disclosed to a third party unless required.
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FEEDBACK OR COMPLAINT SUBMISSION FORM

Contact Information

Declaration