Abuse or Misconduct Reporting Intake Form

Please use this form to report any abuse or misconduct involving minors or vulnerable adults.

The information you submit will be reported to appropriate personnel, who will reach out to you as soon as possible, usually within 1 business day to gather more information. As warranted, it will also be submitted to civil authorities, for investigation purposes. Otherwise, this report will be kept confidential. Your contact information in not required to submit the report.

First name*

Last name*

Street address

City

State/Region

Zip Code

Country/Region

Phone number

Personal Email*

Incident Details

Please provide information regarding the incident being reported:

Select the name of the organization where the victim is registered*

Age of victim at time of incident?

Any potential witnesses?

What is your relationship with the suspected abuser and/or victim?

Has the incident been reported to anyone other than InjureFree?

Parties Involved

When and where did the incident occur?

CA State Soccer Cup, North High School, etc...

Summary of Incident

Date submitted*

Month/Day/Year

Please upload any pertinent information related to this abuse and misconduct submission