Your Name *

Your Email *

Complainant Information

Complainant Role *

Phone *

If Complainant is a Minor please check the box, and fill the subsequent 5 fields

Complainant is a Minor *

Please Select if Minor

First Name

Last Name

Relationship to Complainant

Phone

Email

Information Regarding Complaint

Primary Person Involved in the Complaint

First Name *

Last Name *

Team

Age Group *

Division *

Team Color *

Complaint

Nature of Compliant *

Date *

Time *

Location *

Summary of Incident *

Names/Contact Information of Witnesses *

Acknowledgement

I hereby certify that to the best of my knowledge and belief that the above-mentioned information is true, accurate and complete. I am aware that making false, malicious or frivolous allegations is in violation of the WHC Game and Conduct Policy and subject to disciplinary action by Wolverines Hockey Club. I further recognize that the contents of this document and any attachments (with the exception of any witness list provided) will be shared with the person(s) against whom it has been filed.

Please verify that you are a human.