BDGHA Complaint Form (Belleville Bearcats Hockey)

I. Person making the Complaint

2. Name:^*

Required

(Type in your first and last name)

3. Street Address^*

Required

( 123 Maple St)

4. City / Town^*

Required

5. Postal Code:^*

Required

A2B 3C4

6. Cell Number^*

Required

7. Email Address^*

Required

[email protected] (This email address will receive a receipt / acknowledgement of your submission.)

II. Person on whose behalf the complaint is being made:

(to be completed if different from above)

8. Name:

III. Name of Person(s) against whom you are complaining:

10. Name:^*

Required

11. Title / Role:^*

Required

12. Team^*

Required

13. Name:

14. Title / Role:

15. Team:

16. Have you discussed this matter with the person against whom the complaint is being made?^*

Required

(Yes / No - brief explanation if possible.)

17. What resolution is being sought?^*

Required

18. When did this incident occur?^*

Required

19. Please check the box that best describes your complaint.^*

Required

IV. Details of the Complaint

Provide a summary of the incidents you are complaining about.

20. What happened?^*

Required

21. Where did the incident(s) happen?^*

Required

22. Who was involved (Title & role)?^*

Required

23. How were you treated differently from others (if at all)?^*

Required

Please feel free to attach any additional documents you feel will assist in understanding this complaint.

Allowed extensions: .jpeg, .jpg, .png, gif, .pdf, .doc, .docx, .xls, .xlsx, .ppt, .pptx.
Maximum # Files: 5. Maximum File Size: 4MB.

24. How do the incident(s) relate to your selection in Question 19 (List of Complaints)^*

Required

25. What remedy/resolution are you seeking?^*

Required

BDGHA Complaint Form (Belleville Bearcats Hockey)

I. Person making the Complaint

II. Person on whose behalf the complaint is being made:

III. Name of Person(s) against whom you are complaining:

IV. Details of the Complaint

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