WKO - Safeguarding Concern Report

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This report is for anyone wishing to report a safeguarding concern about a WKO club.

WKO will take reports seriously and investigate accordingly.

Please be mindful for safeguarding concerns to also notify your local members borough council. As each UK borough has many different requirements and your local council can act accordingly within their infrastructure for their local county.

Email *

Club Member Name *

Date of Birth *

YYYY

Club Member Licence Number *

Expiry Date: *

YYYY

Club Name *

Club Instructor Name *

Primary Martial Art? *

Have you made a report before? *

Your club address? *

Gym or Event concern identified at? *

Name of Instructor or Training Partner who caused your concern? *

Details of concern raised? *

Date of concern? *

YYYY

Have you reported this concern to your local council? *

Yes

If Yes to the above which local council did you report it to? *

Did you reported this concern to the police? *

Yes

If Yes to the above which police station did you report it to? *

In order for WKO to proceed with this investigation you understand we have to refer to the concern you have given us with the accused, we will not disclose your name in the investigation but have to disclose the circumstances of the concern, so this can be discussed with who is being accused, so we can both identify what has happened and that the person accused does not do this in future? *

Yes

Required

Concern Declaration *

I declare to the best of my knowledge the concern listed above is a true reflection of what occurred

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