REPORT AND COMPLAINTS FORM
This form is part of the NRAA Complaints, Disputes and Discipline policy. Use this form to submit Complaints and Reports to the West Australia Rifle Association Inc. (WARA).
SECTION 1 - RELEVANT SPORT
Relevant Sport
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Please Select
Target Rifle Shooting
SECTION 2 - SUBMITTER INFORMATION
Full Name
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First Name
Last Name
Date of Birth
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-
Month
-
Day
Year
Gender
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Male
Female
Non-binary/gender diverse
Prefer not to say
Other (please specify):
Preferred Contact Number
*
Please enter a valid phone number - numbers only
Email Address
*
example@example.com
City
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State
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Please Select
ACT
NSW
NT
QLD
SA
TAS
VIC
WA
Country
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Street Address
Street Address Line 2
City
State
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
SID Number
5 digit number - if applicable
State /Territory Association
Please Select
ACTFBTRA
NQRA
NSWRA
NTRA
QRA
SARA
TRA
VRA
WARA
If applicable
Role or Position in Sport
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Administrator
Board/Committee member
Parent
Athlete/player
Spectator
Coach/Assistant Coach
Support Personnel
Employee (paid)
Official/Referee/Umpire
Other (please specify)
Is your position in Sport a volunteer position, athlete or paid employment?
*
Volunteer
Athlete
Paid employee
Other (please describe)
If you are employed by the Sport, please describe your position.
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SECTION 3 - WHO THE CONDUCT OCCURRED TO
Are you submitting a report on behalf of someone else?
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Yes
No
Name of Person affected by the Alleged Conduct
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First Name
Last Name
Is this person aware this matter is being Reported?
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Yes
No
Do you have written consent from the person to act on their behalf? If you are not the legal guardian of this person, please attach written consent from the person that you are acting on behalf of. You will be asked to upload your written consent at the end of Section 5 of this form.
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Yes
No
Your relationship to this Person
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Their Date of Birth
*
-
Month
-
Day
Year
Their Email Address
*
example@example.com
Their Gender
*
Male
Female
Non-binary/gender diverse
Prefer not to say
Other (please specify):
Their Role or Position in Sport
*
Administrator
Board/Committee member
Parent
Athlete/player
Spectator
Coach/Assistant Coach
Support Personnel
Employee (paid)
Official
Other (please specify)
Is their position in Sport a volunteer position, athlete or paid employment?
*
Volunteer
Athlete
Paid employee
Unsure
Other (please describe)
If they are employed by the Sport, please describe their position.
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SECTION 4 - RESPONDENT DETAILS
Name of person or organisation
*
Note: a Respondent may be a person, a club, an organisation or an NSO.
Respondent's Role or Position in Sport
*
Administrator
Organisation/Club
Parent
Athlete/player
Spectator
Coach/Assistant Coach
Support Personnel
Employee (paid)
Board/Committee member
Official
Other (please specify)
Person affected by conduct's Relationship to this Person
*
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SECTION 5 - INCIDENT DETAILS
Relevant Policy
*
Member Protection Policy
Safeguarding and Young People Policy
Competition Manipulation and Sport Gambling Policy
Improper Use of Drugs and Medicine Policy
Code of Conduct
Social Media Policy
Unsure of Exact Policy
Other (please specify)
Alleged Prohibited Conduct by the Respondent
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Note: If possible, review the relevant Policy to determine which Prohibited Conduct you think is the most applicable to this matter. If you are unsure, answer "unsure".
Date/s of Alleged Prohibited Conduct
*
Day and date format required, i.e. Monday 1 April 2024. Please separate dates with a comma ,
Location/address of Alleged Prohibited Conduct
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Description of Alleged Prohibited Conduct
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Note: Please provide as much information as possible, including details about who was involved, what happened and/or how you found out about the alleged Prohibited Conduct if it did not happen to you. If you have included the details of more than one person the Prohibited Conduct happened to above, you should reiterate the names of each Respondent when you explain how each person was involved and what happened to each person. You can attach any relevant supporting documents or images at the end of Section 5.
Were there any witnesses to the Alleged Prohibited Conduct?
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Yes
No
Witness 1
Name
Phone
Email
State / Province
Postal / Zip Code
Witness 2
Name
Phone
Email
State / Province
Postal / Zip Code
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SUPPORTING DOCUMENTS AND OUTCOME
Please upload any supporting documents for your Complaint or Report
Choose Files
Drag and drop files here
Choose a file
Attach any documents or images you would like to include to support your Complaint or Report. Maximum 5 files. 25MB total limit (each image/document cannot excedd 5MB). Allowed types: gif, jpg, jpeg, png, pdf, doc, docx
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of
What outcome are you seeking from lodging your Complaint or Report?
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Apology
Education
Supervision
Suspension
Ban from Sport
Other (can be discussed during the Complaints process)
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SECTION 6 - REPORTING
Have you reported the alleged conduct to another organisation, body or agency? Note: For example, to a sporting body at any level including a National Sporting Organisation, State Sporting Organisation or Club, a law enforcement agency, or an anti-discrimination or equal opportunity agency?
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Yes
No
If yes, provide contact details of the organisation, body, or agency, as well as any actions taken and outcomes of the report
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Declaration
By signing this form, you accept and acknowledge that information contained within this submission will be treated with the highest level of confidentiality however, may be shared in consultation with the Complaints Manager of the National Rifle Association of Australia (NRAA).
Signed by Submitter of form
*
Date
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Month
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Day
Year
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