CONFLICT SUBMISSION FORM

IMPORTANT NOTICE - Please Read Before Proceeding

This form is NOT to be used for:

Concerns related to team communication
Coaching decisions
Team management
Discipline and internal conduct

Concerns involving the following MUST be submitted directly to BC Hockey's Independent Third Party (ITP):

Harassment
Bullying
Abuse
Maltreatment
Physical misconduct

These serious complaints must be investigated under BC Hockey and Hockey Canada's Maltreatment, Bullying, and Harassment Protection and Prevention Policy and are not handled through VMHA's internal process.

1. Person making the complaint:

Player Parent Volunteer Official Employee

Name:

Mailing Address:

Street/Box Number:

City:

Postal Code:

Phone Number:

Email:

2. Person on whose behalf the complaint is made:

(to be completed if different from above)

Name:

3. Name of person(s) against whom you are complaining:

Name:

Title/Role:

Hockey Association:

Name:

Title/Role:

Hockey Association:

4. When did the incident occur?

Date:

5. Particulars:

Provide a summary of the incidents you are complaining about. Your summary must answer the following questions. Section 5 is to be no longer than 2 pages. You may attach any additional documents as necessary.

a) Date incident(s) happened?

b) Where did the incident(s) happen?

c) Who was involved (Name and title/role)?

d) What happened?

e) How were you treated differently from others (if at all)?

f) How do the incident(s) relate to the ground(s) you selected?

g) Remedy / Resolutions you are seeking?