Make an Integrity Complaint or Report

Name

First Name

Last Name

Are you over 18? *

Yes

No

What is your role in wheelchair rugby? *

Select all that apply to your complaint or report

Administrator

Athlete

Parent / Guardian

Spectator

Official

Classifier

Board / Committee Member

Coach / Assistant Coach

Employee

Volunteer

Carer / Support Worker

Team Staff

Other

Date of incident *

MM

DD

YYYY

Are there any witnesses to this incident? *

Yes

No

If appropriate, would you consent to mediation with the Respondent? *

Yes

No

Please check *

I accept that the information provided may be used and disclosed for the purposed outlined in the WRA Privacy Policy. If your report includes information about potential imminent harm, an ongoing risk of harm or information about criminality, we may provide your details or information from your report to relevant law enforcement or other relevant parties.