Written Statement (Witness Statement)

Written Statement (Witness Statement)

Prescribed Form 12
Your Name*

First NameLast Name
You are*

18 years of age or older17 years of age or younger
If you selected that you are 17 years of age or younger, please have your parent/guardian present when you submit your report and enter their email address in the section below.
Your Email Address (parent/guardian email address of persons under 18)*
example@example.com
Your Club Name*
I am a:*
Details
Key Points for your incident report:

- Only facts, do not submit any opinions

- A short, clear and concise report is required. What you saw and/or what you heard. Hearsay will not be accepted.

- It's important to remember where you were in relation to the incident (the actual location/distance from incident).

- Indicate distinguishing details of the Participants of the incident (e.g. red cap /black t-shirt).

- You can either use dot points or paragraphs.

- You may upload files. For larger files, please contact the HVFA Office.
Write your Report Here*
File Upload

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Type a question*

I certify that the information provided is true and accurate
Should be Empty:

Details