Oregon Adaptive Sports | Outdoor Recreation for People with Disabilities.


SPORT PROTECTION REPORTING
Offender Information:
This section is about the individual you are reporting. Please provide as much information as possible.
Name of the Individual you are reporting: *
Offender's Street Address
Offender's City
Offender's State
Gender of Individual *	Male Female Other
Organization where this individual works or volunteers currently or has in the past:
Position(s) this individual holds or held:	Instructor/ Coach Assistant Employee Volunteer Family Member Community Member Other/Not Sure
Incident Information:
This section asks questions about the incident or incidents you are reporting. Please provide as much specific information as you are able.
Type of Offense (i.e. what happened?): *
Where did the incident or incidents take place? (City, State and any other available location information) *
Please Describe what happened: (Including... Who, What, When, Where) *
Victim Information:
This section is for information about the victim or victims. If you are the victim and wish to remain anonymous, you may do so. In that case, please enter only your age, city, state.
Name
Age (or approximate age): *
City *
State/Province *
Gender	Male Female Other
Contact phone number:
(Note, if this individual is under 18, please provide contact information for parent or guardian)
Contact Email address:
(Note, if this individual is under 18, please provide contact information for parent or guardian)
Reporter Information:
You may remain anonymous if you wish. However, providing your information is vastly helpful to a swift and effective investigation. A person reporting alleged misconduct should not fear any retribution and/or consequence when filing a report he or she believes to be true.
Reporter Name
Relationship to Victim (if any)	Parent/ Guardian Other Family Member Friend or Acquaintance OAS Instructor OAS Assistant Other or Prefer not to say
Phone Number
Email Address
Other Information:
If you have any other information that you feel would be helpful to an investigation of the alleged offense you have reported, please enter it here.
Comments:

Timeout Warning

SPORT PROTECTION REPORTING

Offender Information:

Incident Information:

Reporter Information:

Other Information: