The Reporting of abuse is an important Safe Sport step that protects our athletes. Your willingness to report inappropriate behavior is sincerely appreciated and needed. By submitting this form, you are giving permission to your YMCA's Swimming's Safe Sport Program contact to follow up with you. Out of respect for the importance of this issue and to encourage honest and effective reporting, knowingly making a false or vindictive report will not be tolerated and may be a violation of your YMCA's Swim Team Code of Conduct.

Person Being Reported

Provide as much information as possible about the person you are reporting.

First Name *

Last Name *

Age or Approximate Age *

Gender *

Male

Female

Team Affiliation or "None" if unknown *

Position(s) this individual holds or held *

Alleged Offense Information

Provide as much specific information as you are able.

Type of Offense (select all that apply) *

Location that the incident(s) took place. Enter Unknown or city, state, specific location, etc. *

Date(s) of Alleged Offense *

Description of Alleged Offense (include as much detail as possible). *

Knowledge of victim(s) involved in the alleged offense. *

I am not aware of any victim(s) involved in the alleged offense

I am aware of a victim(s) involved in the alleged offense

Victim or Victims

If you are the victim and wish to remain anonymous, you may do so. In that case, please enter your name as Anonymous. You may also be unaware of who the victim is. In that case, please enter Unknown.

First Name *

Last Name *

Age or Approximate Age *

Team Affiliation (or None) *

Gender *

Male

Female

Additional Information *

Individual(s) Who May Have Additional Information

List anyone who may be able to provide additional information regarding the alleged offense. We will not identify you when we contact these individuals.

First Name *

Last Name *

Phone Number (Include Area Code) *

E-mail Address *

Team Affiliation (or None) *

First Name *

Last Name *

Phone Number (Include Area Code) *

E-mail Address *

Team Affiliation (or None) *

Report Submitted By

You may remain anonymous if you wish. However, providing your information is vastly helpful to a swift and effective investigation. All reports are kept strictly confidential by your Safe Sport Program. A person reporting alleged misconduct should not fear any retribution and/or consequence when filing a report he/she believes is true.

First Name (or Anonymous or Unknown) *

Last Name (or Anonymous or Unknown) *

Phone Number (Include Area Code) *

E-mail Address *

Team Affiliation (or None) *

Relationship to victim (if any) *

Other Information

Enter any other information that you feel would be helpful to an investigation of the alleged offense you have reported: