Incident Reporting Form
JUSC is dedicated to providing a positive and safe environment free from unsportsmanlike conduct, harassment, sexual, emotional and physical abuse and misconduct, and bullying.

This form is for reporting incidents of poor behavior, misconduct or prohibited conduct on part of youth or adult participants as described in the club's Code of Conduct Policy.
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Reporter Name *
Please enter your first and last name.
Reporter Email Address *
Please enter the email address you would like us to respond to.
Reporter Phone Number *
Please enter the phone number you would like us to respond to.
Date of the Incident
Please provide the date of incident where applicable.
MM
/
DD
/
YYYY
Location of Incident
Please provide the location of the incident where applicable.
Description of Incident *
Please provide a description of the incident.
Parties Involved *
Name of the person(s) or group believed to have acted improperly.
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