Witness Statement
East Brighton Vampires JFC
Personal Details
Person Completing Form OR Completing on Behalf of a Child Member
Date
-
Month
-
Day
Year
Date this form is being completed
Name
*
First Name of person completing form
Last Name of person completing form
Mobile
*
-
Area Code
Phone Number
Email
*
example@example.com
Details of Incident
Date
*
-
Month
-
Day
Year
Date the Incident took place
Quarter (First, Second, Third or Fourth)
*
Alternatively, if Incident took place between quarters or after game, please note this.
Approximate Time (How Long into Quarter)
Alternatively, if Incident took place between quarters or after game, please note this.
Opposition Team
*
Name of the opposition team
Competition
*
Age group, Division & Competition (Mixed, Boys or Girls)
Ground
*
Name of ground will suffice
Your presence at the game was as a
*
Player, Official (Coach, Trainer, Team Manager etc.) or Spectator
Description
Describe your personal, direct observations of the incident in as much detail as you can, including where possible, individual player numbers and descriptions of identification, location on the ground (or off-field), etc. Do not rely on what others have told you, only what you actually saw, or heard if that is relevant(such as the contact itself, or any inflammatory comments, etc). This may not be the actual incident itself, e.g. you may have seen a player lying on the ground with another player running away, without observing the actual contact itself, etc. Include details of any observed injuries}.
Statement
Other Comments
Add any other relevant information you consider important.
Submit
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