Complaint form

Who should you use this form?

Any person directly involved or the parent/guardian in the case of a minor.
A representative from the sport organizations

This form should be used to:

  • i) file a complaint of maltreatment, as defined by the Universal Code of Conduct to Prevent Maltreatment in Sport (UCCMS), or

  • ii) file a complaint alleging a failure on the part of a Provincial Sport Organization (PSO) to follow

its constitution and/or by-laws.
There is no cost to use this program.
Please allow up to three (3) working days to receive acknowledgement of your complaint.

PART A – COMPLAINANT INFORMATION

Complete address

If yes, please provide contact details for your representative

REPRESENTATIVE

Complete address

PART B – RESPONDENT INFORMATION

Please provide as much information as possible, if there are more than three (3) respondents, please attach additional details to this form.


RESPONDENT #1:

Complete address

RESPONDENT #2:

Complete address

RESPONDENT #3:

Complete address

PART C – DETAILS OF THE COMPLAINT

Please provide as much information as possible


Please list date(s) of incident(s), please add multiple dates if applicable (mm/dd/year). If there are more than the allotted spaces, please attach additional details to this form.


WITNESS #1:

WITNESS #2:


WITNESS #3:


PART D –OTHER INFORMATION


** If the complaint was heard through another formal complaint process, you cannot submit the same complaint.


REPORTING OF LEGAL MATTERS


Please note that administrators of this Program have a “duty to report” if the alleged complaint deals with maltreatment. If reported to proper legal authorities, please provide report reference number or authority contact information when emailing this form — please do not include any legal and/or private documents.


PART E – DECLARATION

I hereby declare that the information I have provided in this complaint is true and correct to the best of my knowledge.

I accept that the complaint will be shared with the respondent(s).

I accept that the information provided may be used and disclosed to the proper legal authorities and arbitrators/mediators for the purposes of this program.


PART F – FOR INTERNAL USE ONLY