Sports Protection Reporting

Sports Protection Reporting

Use this form to report any misconduct by Summit Adaptive Sports. VERY IMPORTANT: Cases involving sexual abuse and molestation MUST BE REPORTED to law enforcement authorities - notifying and making a report to Summit Adaptive Sports does not satisfy this obligation.
Name of Individual you are reporting/that caused the offense. *

First NameLast Name
Address (if known, otherwise fill in unknown)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Gender*

MaleFemaleNon-Binary
Organization where the individual works and/or volunteers, or worked/volunteered previously. (Please provide as much information as you can, but if you do not know specific information please enter 'Not Sure'.) *
Position (s) this individual holds or previously held.*

CoachEmployeeVolunteerOther/Not Sure
Incident Information

This section asks questions about the incident or incidents you are reporting. Please provide as much specific information as you are able.
Type of Offense (i.e. specifics on what happened?) *
Where did the incident or incidents take place? (City, State, any other location information available)? *
Describe what happened (e.g. who, what, when, where, etc..).*
Victim Information

This section is for information about the victim or victims. If you are the victim and wish to remain anonymous, you may do so. In that case, please enter only your age, city, state and chapter affilition (if applicable).
Name*

First NameLast Name
Age (approximate is ok)*
Chapter/Organization Affiliation (if any)
If none or unknown type in "none known".
Phone Number
Please enter a valid phone number.
Parent or Guardian Name if under 18*

First NameLast Name
Contact Email
example@example.com
Gender

MaleFemaleNon-Binary
Reporter's Information

You may remain anonymous if you wish. However, providing your information is vastly helpful to a swift and effective investigation. A person reporting alleged misconduct should not fear any retribution and/or consequence when filing a report he or she belives to be true.
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Chapter Affiliation (if any):
Relationship to the victim (if any):*

SelfParent/GuardianOther Family MemberFriend or AcquaintanceChapter Member, Coach or VolunteerOther or Prefer not to say
Other Information that you feel would be helpful to an investigation of the alleged offense you have reported, please enter it here:
Date*

MonthDayYear
Date
Should be Empty: