PCY Incident Report Form

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Please fill out this form if you have one of the following concerns:
-Peer to Peer Bullying
-Adult to Athlete bullying
-Parent Issues
-Violations of team rules and team code of conduct

Filling out this form with notify Coach Shay Spelman. Coach Shay will read, document, and address the concerns in a timely manner.

Your Name (type anonymous if you do not wish to be identified)

Your email (leave blank if you wish to be anonymous)

Are you a swimmer, parent, coach, or other? *

Swimmer

Parent

Coach

Other:

Who is the person doing the bullying/ breaking the code of conduct? If they are a swimmer, please also state their group if possible

Who is the person being bullied? If it is a swimmer please state their group if possible. IF YOU OR THE VICTIM DOES NOT WISH TO BE IDENTIFIED PLEASE WRITE "ANONYMOUS"

Please describe the actions that have occured. Please use names so the story is clear. If the victim wishes to be anonymous use the term "victim" while stating actions. Please include dates and times if possible.

Would you like an in person meeting to discuss the actions?

Yes

Maybe

Clear selection

Which coaches would you like present at this meeting?

Mike Leonard (head coach)

Cary Belyea (Level VI)

Megan Feichtner (Level V)

Stacey Tepe (Level IV and Masters)

Shay Spelman (Level IV)

Sarah Hammer (Level III)

Mary Proctor (Level III)

Joy Wood (Level III)

Cindy Kamp (Level II)

Diane Valentine (Level I)

Amy Grider (Level I)

Katie Magee (Gator Division)

Scott Ryan (Gator Division)

Kevin Huey (Clippard Division)

Jenny Reece (Clippard Division)

Bill Profitt (Strength Coach)

Submit

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