Complaint Form (South Simcoe Minor Hockey Association)

Complaint Form

To the South Simcoe Minor Hockey Association, this letter is to inform your committee of a complaint and improper behaviour that was witnessed at a SSMHA event in front of spectators, players, coaches and or/officials. We bring this to your attention with the knowledge that your committee will review the complaint and decide if the SSMHA Code of conduct has been violated.

Contact Information

Last Name:^*

First Name:^*

Email Address:^*

Example: [email protected]. Your submission will be sent to this address.

Phone Number:^*

Example: ###-###-####

Report Information

To be completed 24 hours after the incident or complaint.

Team Name:^*

Date of Incident:^*

Time of Incident:^*

Place that the incident took place^*

Witnesses

Please provide at least one witness

Witness #1 Name:^*

Witness #1 Phone Number:^*

Example: ###-###-####

Witness #2 Name:

Witness #2 Phone Number:

Example: ###-###-####

Incident or Complaint

Please complete with details of the incident

Incident or Complaint details:^*

Due to the highly confidential nature of the information contained on this form, the South Simcoe Minor Hockey Association is committed to providing limited, restricted, and secured access to this information. As a result, to assist us in our effort to maintain your privacy, we request you do not disclose or provide this form or any information related to this form, to any individual other than the Risk Management Director, President and 1st Vice President for the South Simcoe Minor Hockey Association.

I agree to the terms and conditions stated above^*

Complaint Form (South Simcoe Minor Hockey Association)

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Contact Information

Report Information

Witnesses

Incident or Complaint

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