APRMHA Complaint Submission Form (Ajax Pickering Minor Hockey)

APRMHA Complaint Submission Form

To lodge a formal complaint, please use this form. Complaints must be filed within 5 days of the alleged incident(s). Anonymous complaints or incomplete forms will not be investigated. This form is to be completed only after a resolution at the team level with the parent rep is found to be unsatisfactory by the Complainant.

PERSON SUBMITTING THE COMPLAINT

First/Last Name:^*

Required

Full first and last name must be provided.

Role of Complainant: ^*

Required

Choose One of the options from the drop down menu.

Phone Number:^*

Required

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

Email Address:^*

Required

Example: [email protected]

TEAM INFORMATION

Team Name:^*

Required

Indicate the team you are on (ex. U12AA or U11 House League Blue)

Name of Coach:^*

Required

RESPONDENT INFORMATION

Person Complaint Being Filed Against:^*

Required

Respondent's Name

Title or Role of Respondent within the APRMHA:^*

Required

NATURE OF THE COMPLAINT

Nature of the Complaint:^*

Abuse
Code of Conduct
Harassment
Other

Check All That Apply

Describe the Complaint:^*

Required

Identity the facts and issues. Please only provide specific information related to the complaint. Avoid long narratives were applicable.

Was the Team Coach Contacted prior to completing this form: ^*

Required

Why was the Team Coach not contacted prior to completing this form:

Add a brief description why.

Have attempts been made to resolve the complaint?^*

Required

Have attemps been made to resolve the complaint?

If you answered no, please specify.

When did the incident occur?^*

Required

I confirm that the information provided in this form is accurate, truthful and free from any mal-intent.

I have read all important information on the APRMHA Dispute Resolution webpage, outlining the Dispute Resolution process and the intended use of this form.

I understand that this form will be sent to the APRMHA Executive and information will be shared with the Dispute Resolution Committee. A follow up will be issued within 5 business days, or earlier depending on the nature of the complaint.

Follow up emails/phone calls will not be responded to during the time frame mentioned above.

I agree to the terms and conditions stated above^*

APRMHA Complaint Submission Form (Ajax Pickering Minor Hockey)

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PERSON SUBMITTING THE COMPLAINT

TEAM INFORMATION

RESPONDENT INFORMATION

NATURE OF THE COMPLAINT

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