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2. Information
   This section is about the individual you are reporting. Please provide as much information as possible. If you prefer, a report can be filed over the phone by calling the East Grand Rapids Parks & Recreation Department at 616-949-1750.
4. Name of individual you are reporting (First & Last)*
5. Age or approximate age*
6. Gender*

   1. Male
   2. Female
8. Address
10. City
11. State
12. Zip
14. Position(s) this individual holds or held*

    1. Head Coach
    2. Assistant Coach

    1. Instructor
    2. Official

    1. Volunteer
    2. Team Parent

    1. Other/Not Sure
16. Misconduct Incident Information
    This section asks questions about the misconduct incident or incidents you are reporting. Please provide as much specific information as you can.
18. Misconduct Incident(s)*
    Please describe in detail the misconduct incident you are reporting.
20. Location*
    Where did the misconduct incident take place?
22. Date and time of the misconduct incident
    Date and time of the misconduct incident

    Date and time of the misconduct incident
23. Was law enforcement called at the time of the misconduct incident?*

    1. Yes
    2. No
25. Witness List and Phone Number
    List any and all individuals who were a witness of the misconduct incident.
27. Victim
    This section is for information about the victim. If you are the victim and wish to remain anonymous, you may do so. In that case, enter only your age, program or sport you are participating in.
29. Name of victim (First & Last)
30. Age of victim*
31. Gender*

    1. Male
    2. Female
33. Victim contact phone number
    If person is under 18, please provide contact information for his/her parent of guardian.
34. Victim Email Address
    If person is under 18, please provide contact information for his/her parent of guardian.
36. Additional comments by the victim
38. Individual reporting
    Your information: you may remain anonymous if you wish. However, providing your information is extremely helpful for a swift and effective investigation. A person reporting alleged misconduct should not fear any retribution and/or consequences when filing a report he or she believes to be true.
40. First Name
41. Last Name
43. Phone Number
44. Email address
46. Relationship to the victim*

    1. Self
    2. Parent/Guardian

    1. Other family member
    2. Friend or acquaintance

    1. Coach
    2. Instructor

    1. Sport Official
    2. Other or prefer not to say
48. Additional comments:
Leave This Blank:


55. 1. Receive an email copy of this form.
56. Email address

    This field is not part of the form submission.

57. Submit

* indicates a required field