Person who concerns are for
Subject of Concern
Person who concerns are about
Are you aware of any local authority /police involvement in this case? If yes, please provide details
Include all the relevant information, such as detailed description of your concerns and reasons for these. Please describe any injuries or actions causing concern and whether you are recording these as fact, opinion or hearsay.
Please provide details of any one who has shared your concerns or witnessed any incident: Name, Position within the sport or relationship to the individual concerned, DOB, Address, Postcode, Telephone Number, Email Address
Do you have any relationship with anyone involved in this case which could cause a conflict of interest in any investigations? If yes, please describe your relationship