Grassroots Discrimination Reporting Form

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href="/scottish-cup/scottish-gas-mens-scottish-cup/scottish-cup-predictor-powered-by-scottish-gas/my-account/">My Account</a> </li> </ul> </li> <li> <a href="/scottish-cup/scottish-gas-mens-scottish-cup/archive/">Archive</a> <ul class="dropdown-menu"> <li> <a href="/scottish-cup/scottish-gas-mens-scottish-cup/archive/scottish-cup-history/">Scottish Cup History</a> <ul class="dropdown-menu"> <li><a href="/scottish-cup/scottish-gas-mens-scottish-cup/archive/scottish-cup-history/the-history-of-the-cup/">The History of the Cup</a></li> <li><a href="/scottish-cup/scottish-gas-mens-scottish-cup/archive/scottish-cup-history/scottish-cup-winners/">Scottish Cup Winners</a></li> </ul> </li> </ul> </li> </ul> </li> <li> <a href="/scottish-cup/scottish-gas-womens-scottish-cup/">Scottish Gas Women's Scottish Cup</a> <ul class="dropdown-menu"> <li> <a href="/scottish-cup/scottish-gas-womens-scottish-cup/news/">News</a> </li> <li> <a href="/scottish-cup/scottish-gas-womens-scottish-cup/fixtures-results/">Fixtures & Results</a> </li> <li> <a href="/scottish-cup/scottish-gas-womens-scottish-cup/format-rules/">Format & Rules</a> </li> <li> <a href="/scottish-cup/scottish-gas-womens-scottish-cup/womens-scottish-cup-past-winners/">Women's Scottish Cup Past Winners</a> </li> </ul> </li> <li> <a href="/scottish-cup/youth-cup/">Youth Cup</a> <ul class="dropdown-menu"> <li> <a href="/scottish-cup/youth-cup/news/">News</a> </li> <li> <a href="/scottish-cup/youth-cup/fixtures-results/">Fixtures & Results</a> </li> <li> <a href="/scottish-cup/youth-cup/format-rules/">Format & Rules</a> </li> <li> <a href="/scottish-cup/youth-cup/youth-cup-past-winners/">Youth Cup Past Winners</a> </li> </ul> </li> <li> <a href="/scottish-cup/hampden-hospitality/">Hampden Hospitality</a> </li> <li> <a href="/scottish-cup/scottish-gas-hub/">Scottish Gas Hub</a> <ul class="dropdown-menu"> <li> <a href="/scottish-cup/scottish-gas-hub/cups/">Cups</a> </li> <li> <a href="/scottish-cup/scottish-gas-hub/camps/">Camps</a> <ul class="dropdown-menu"> <li> <a href="/scottish-cup/scottish-gas-hub/camps/scottish-gas-para-festivals/">Scottish Gas Para Festivals</a> </li> </ul> </li> </ul> </li> </ul> </li> <li> <a href="/performance/" class="dropdown-toggle dropdown-nav" data-toggle="dropdown" aria-haspopup="true" aria-expanded="false"> <span>Performance <i class="fa fa-angle-double-down"></i></span> </a> <ul class="dropdown-menu"> <li> <a href="/performance/news/">News</a> </li> <li> <a href="/performance/jd-performance-schools/">JD Performance Schools</a> <ul class="dropdown-menu"> <li> <a href="/performance/jd-performance-schools/braidhurst-high-school-motherwell/">Braidhurst High School Motherwell</a> </li> <li> <a href="/performance/jd-performance-schools/broughton-high-school-edinburgh/">Broughton High School Edinburgh</a> </li> <li> <a href="/performance/jd-performance-schools/graeme-high-school-falkirk/">Graeme High School Falkirk</a> </li> <li> <a href="/performance/jd-performance-schools/grange-academy-kilmarnock/">Grange Academy Kilmarnock</a> </li> <li> <a href="/performance/jd-performance-schools/hazlehead-academy-aberdeen/">Hazlehead Academy Aberdeen</a> </li> <li> <a href="/performance/jd-performance-schools/holyrood-secondary-glasgow/">Holyrood Secondary Glasgow</a> </li> <li> <a href="/performance/jd-performance-schools/st-johns-high-school-dundee/">St John's High School Dundee</a> </li> <li> <a href="/performance/jd-performance-schools/applications/">Applications</a> </li> </ul> </li> <li> <a href="/performance/club-academy-scotland/">Club Academy Scotland</a> <ul class="dropdown-menu"> <li> <a href="/performance/club-academy-scotland/fixtures-results/">Fixtures & Results</a> </li> </ul> </li> <li> <a href="/performance/next-gen/">Next Gen</a> <ul class="dropdown-menu"> <li> <a href="/performance/next-gen/fixtures-results/">Fixtures & Results</a> </li> </ul> </li> </ul> </li> <li> <a href="/football-development/" class="dropdown-toggle dropdown-nav" data-toggle="dropdown" aria-haspopup="true" aria-expanded="false"> <span>Football Development <i class="fa fa-angle-double-down"></i></span> </a> <ul class="dropdown-menu"> <li> <a href="/football-development/news/">News</a> </li> <li> <a href="/football-development/participation/">Participation</a> <ul class="dropdown-menu"> <li> <a href="/football-development/participation/childrens-youth-football/">Children's & Youth Football</a> <ul class="dropdown-menu"> <li> <a href="/football-development/participation/childrens-youth-football/children-youth-player-pathway/">Children & Youth Player Pathway</a> <ul class="dropdown-menu"> <li><a href="/football-development/participation/childrens-youth-football/children-youth-player-pathway/6-8-years-old/">6-8 Years Old</a></li> <li><a href="/football-development/participation/childrens-youth-football/children-youth-player-pathway/9-12-years-old/">9-12 Years Old</a></li> <li><a href="/football-development/participation/childrens-youth-football/children-youth-player-pathway/13-years-old-over/">13 Years Old & Over</a></li> </ul> </li> <li> <a href="/football-development/participation/childrens-youth-football/mini-kickers/">Mini-Kickers</a> </li> <li> <a href="/football-development/participation/childrens-youth-football/cashback-for-communitites/">Cashback for Communitites</a> </li> <li> <a href="/football-development/participation/childrens-youth-football/mcdonalds-fun-football/">McDonald's Fun Football</a> </li> <li> <a href="/football-development/participation/childrens-youth-football/heading/">Heading Guidelines</a> </li> </ul> </li> <li> <a href="/football-development/participation/adult-18-yearsplus-football/">Adult (18 years+) Football</a> <ul class="dropdown-menu"> <li> <a href="/football-development/participation/adult-18-yearsplus-football/futsal/">Futsal</a> </li> <li> <a href="/football-development/participation/adult-18-yearsplus-football/walking-football/">Walking Football</a> </li> <li> <a href="/football-development/participation/adult-18-yearsplus-football/heading-guidance/">Heading Guidance</a> </li> </ul> </li> <li> <a href="/football-development/participation/girls-womens-football/">Girls' & Women's Football</a> <ul class="dropdown-menu"> <li> <a href="/football-development/participation/girls-womens-football/kdm-group-soccer-centres/">KDM Group Soccer Centres</a> <ul class="dropdown-menu"> <li><a href="/football-development/participation/girls-womens-football/kdm-group-soccer-centres/north-region/">North Region</a></li> <li><a href="/football-development/participation/girls-womens-football/kdm-group-soccer-centres/central-region/">Central Region</a></li> <li><a href="/football-development/participation/girls-womens-football/kdm-group-soccer-centres/west-region/">West Region</a></li> <li><a href="/football-development/participation/girls-womens-football/kdm-group-soccer-centres/east-region/">East Region</a></li> <li><a href="/football-development/participation/girls-womens-football/kdm-group-soccer-centres/south-west-region/">South West Region</a></li> <li><a href="/football-development/participation/girls-womens-football/kdm-group-soccer-centres/south-east-region/">South East Region</a></li> </ul> </li> <li> <a href="/football-development/participation/girls-womens-football/spar-future-stars-football-cup/">SPAR Future Stars Football Cup</a> </li> <li> <a href="/football-development/participation/girls-womens-football/uefa-disney-playmakers/">UEFA Disney Playmakers</a> </li> </ul> </li> <li> <a href="/football-development/participation/para-football/">Para-Football</a> </li> <li> <a href="/football-development/participation/grassroots-game-app/">Grassroots Game App</a> </li> </ul> </li> <li> <a href="/football-development/attractive-game/">Attractive Game</a> <ul class="dropdown-menu"> <li> <a href="/football-development/attractive-game/facilities/">Facilities</a> </li> <li> <a href="/football-development/attractive-game/grassroots-awards/">Grassroots Awards</a> <ul class="dropdown-menu"> <li> <a href="/football-development/attractive-game/grassroots-awards/award-categories/">Award Categories</a> <ul class="dropdown-menu"> <li><a href="/football-development/attractive-game/grassroots-awards/award-categories/best-volunteer-in-youth-football/">Best Volunteer in Youth Football</a></li> <li><a href="/football-development/attractive-game/grassroots-awards/award-categories/best-volunteer-in-girls-womens-football/">Best Volunteer in Girls' & Women's Football</a></li> <li><a href="/football-development/attractive-game/grassroots-awards/award-categories/best-volunteer-in-adult-football/">Best Volunteer in Adult Football</a></li> <li><a href="/football-development/attractive-game/grassroots-awards/award-categories/best-para-football-activity-project-or-person/">Best Para-Football Activity, Project or Person</a></li> <li><a href="/football-development/attractive-game/grassroots-awards/award-categories/best-community-football-for-all-project/">Best Community Football For All Project</a></li> <li><a href="/football-development/attractive-game/grassroots-awards/award-categories/best-young-volunteer/">Best Young Volunteer</a></li> <li><a href="/football-development/attractive-game/grassroots-awards/award-categories/best-community-football-club/">Best Community Football Club</a></li> <li><a href="/football-development/attractive-game/grassroots-awards/award-categories/best-fun-football-centreactivitycoach/">Best Fun Football Centre/Activity/Coach</a></li> <li><a href="/football-development/attractive-game/grassroots-awards/award-categories/best-grassroots-referee/">Best Grassroots Referee</a></li> </ul> </li> <li> <a href="/football-development/attractive-game/grassroots-awards/winners/">Winners</a> </li> </ul> </li> <li> <a href="/football-development/attractive-game/discrimination-reporting-form/">Discrimination Reporting Form</a> </li> </ul> </li> <li> <a href="/football-development/coaching/">Coaching</a> <ul class="dropdown-menu"> <li> <a href="/football-development/coaching/news/">News</a> </li> <li> <a href="/football-development/coaching/become-a-coach/">Become a Coach</a> </li> <li> <a href="/football-development/coaching/find-a-course/">Find a Course</a> </li> <li> <a href="/football-development/coaching/coaching-pathway/">Coaching Pathway</a> <ul class="dropdown-menu"> <li> <a href="/football-development/coaching/coaching-pathway/main-youthadult-pathway/">Main (Youth/Adult) Pathway</a> <ul class="dropdown-menu"> <li><a href="/football-development/coaching/coaching-pathway/main-youthadult-pathway/uefa-b-licence/">UEFA B Licence</a></li> <li><a href="/football-development/coaching/coaching-pathway/main-youthadult-pathway/c-licence/">C Licence</a></li> <li><a href="/football-development/coaching/coaching-pathway/main-youthadult-pathway/uefa-youth-b-licence/">UEFA Youth B Licence</a></li> </ul> </li> <li> <a href="/football-development/coaching/coaching-pathway/goalkeeping-pathway/">Goalkeeping Pathway</a> <ul class="dropdown-menu"> <li><a href="/football-development/coaching/coaching-pathway/goalkeeping-pathway/uefa-goalkeeping-a-licence/">UEFA Goalkeeping A Licence</a></li> <li><a href="/football-development/coaching/coaching-pathway/goalkeeping-pathway/uefa-goalkeeping-b-licence/">UEFA Goalkeeping B Licence</a></li> <li><a href="/football-development/coaching/coaching-pathway/goalkeeping-pathway/goalkeeping-coaching-award/">Goalkeeping Coaching Award</a></li> <li><a href="/football-development/coaching/coaching-pathway/goalkeeping-pathway/goalkeeping-coaching-certificate/">Goalkeeping Coaching Certificate</a></li> </ul> </li> <li> <a href="/football-development/coaching/coaching-pathway/childrens-pathway/">Children's Pathway</a> <ul class="dropdown-menu"> <li><a href="/football-development/coaching/coaching-pathway/childrens-pathway/advanced-childrens-coaching-licence/">Advanced Children's Coaching Licence</a></li> <li><a href="/football-development/coaching/coaching-pathway/childrens-pathway/uefa-c-licence-childrens-pathway/">UEFA C Licence (Children's Pathway)</a></li> </ul> </li> <li> <a href="/football-development/coaching/coaching-pathway/futsal-pathway/">Futsal Pathway</a> </li> <li> <a href="/football-development/coaching/coaching-pathway/degree-specialist-courses/">Degree & Specialist Courses</a> <ul class="dropdown-menu"> <li><a href="/football-development/coaching/coaching-pathway/degree-specialist-courses/bsc-hons-football-coaching-performance-development/">BSc (Hons) Football Coaching, Performance & Development</a></li> <li><a href="/football-development/coaching/coaching-pathway/degree-specialist-courses/football-fitness-licence/">Football Fitness Licence</a></li> <li><a href="/football-development/coaching/coaching-pathway/degree-specialist-courses/first-aid-e-learning/">First Aid E-Learning</a></li> <li><a href="/football-development/coaching/coaching-pathway/degree-specialist-courses/coach-educator-award/">Coach Educator Award</a></li> <li><a href="/football-development/coaching/coaching-pathway/degree-specialist-courses/football-unites-e-learning/">Football Unites E-Learning</a></li> <li><a href="/football-development/coaching/coaching-pathway/degree-specialist-courses/early-years/">Early Years</a></li> <li><a href="/football-development/coaching/coaching-pathway/degree-specialist-courses/performance-analysis/">Performance Analysis</a></li> <li><a href="/football-development/coaching/coaching-pathway/degree-specialist-courses/continuous-coach-development/">Continuous Coach Development</a></li> <li><a href="/football-development/coaching/coaching-pathway/degree-specialist-courses/continuous-professional-development/">Continuous Professional Development</a></li> </ul> </li> <li> <a href="/football-development/coaching/coaching-pathway/talent-id-pathway/">Talent ID Pathway</a> <ul class="dropdown-menu"> <li><a href="/football-development/coaching/coaching-pathway/talent-id-pathway/introduction-to-talent-id/">Introduction to Talent ID</a></li> <li><a href="/football-development/coaching/coaching-pathway/talent-id-pathway/talent-id-certificate/">Talent ID Certificate</a></li> <li><a href="/football-development/coaching/coaching-pathway/talent-id-pathway/talent-id-award/">Talent ID Award</a></li> <li><a href="/football-development/coaching/coaching-pathway/talent-id-pathway/talent-id-licence/">Talent ID Licence</a></li> </ul> </li> </ul> </li> <li> <a href="/football-development/coaching/development/">Coaching Development</a> <ul class="dropdown-menu"> <li> <a href="/football-development/coaching/development/coaching-cpd/">Coaching CPD</a> </li> <li> <a href="/football-development/coaching/development/continuous-coach-development-ccd/">Continuous Coach Development (CCD)</a> </li> <li> <a href="/football-development/coaching/development/scottish-football-coaching-podcast/">Scottish Football Coaching Podcast</a> </li> </ul> </li> <li> <a href="/football-development/coaching/coach-education-newsletter/">Coach Education Newsletter</a> </li> <li> <a href="/football-development/coaching/chase-coaching-programme/">Chase Coaching Programme</a> <ul class="dropdown-menu"> <li> <a href="/football-development/coaching/chase-coaching-programme/chase-coaching-programme-application/">Chase Coaching Programme Application</a> </li> </ul> </li> </ul> </li> <li> <a href="/football-development/club-services/">Club Services</a> <ul class="dropdown-menu"> <li> <a href="/football-development/club-services/developing-your-club/">Developing Your Club</a> <ul class="dropdown-menu"> <li> <a href="/football-development/club-services/developing-your-club/club-resources/">Club Resources</a> </li> <li> <a href="/football-development/club-services/developing-your-club/club-stories/">Club Stories</a> <ul class="dropdown-menu"> <li><a href="/football-development/club-services/developing-your-club/club-stories/annan-athletic-case-study/">Annan Athletic Case Study</a></li> <li><a href="/football-development/club-services/developing-your-club/club-stories/blairgowrie-rattray/">Blairgowrie & Rattray</a></li> <li><a href="/football-development/club-services/developing-your-club/club-stories/bonnyrigg-rose-case-study/">Bonnyrigg Rose Case Study</a></li> <li><a href="/football-development/club-services/developing-your-club/club-stories/cumbernauld-colts/">Cumbernauld Colts</a></li> <li><a href="/football-development/club-services/developing-your-club/club-stories/cumnock-juniors-ayr-united/">Cumnock Juniors & Ayr United</a></li> <li><a href="/football-development/club-services/developing-your-club/club-stories/jeanfield-swifts-case-study/">Jeanfield Swifts Case Study</a></li> <li><a href="/football-development/club-services/developing-your-club/club-stories/jimmy-johnstone-academy/">Jimmy Johnstone Academy</a></li> <li><a href="/football-development/club-services/developing-your-club/club-stories/musselburgh-windsor/">Musselburgh Windsor</a></li> <li><a href="/football-development/club-services/developing-your-club/club-stories/turriff-community-football-club/">Turriff Community Football Club</a></li> <li><a href="/football-development/club-services/developing-your-club/club-stories/broxburn-united-case-study/">Broxburn United Case Study</a></li> <li><a href="/football-development/club-services/developing-your-club/club-stories/east-kilbride-united-community-sports-club-case-study/">East Kilbride United Community Sports Club Case Study</a></li> <li><a href="/football-development/club-services/developing-your-club/club-stories/sauchie-juniors-academy-case-study/">Sauchie Juniors Academy Case Study</a></li> <li><a href="/football-development/club-services/developing-your-club/club-stories/hermes-bridge-of-don-yfc-case-study/">Hermes Bridge of Don YFC Case Study</a></li> </ul> </li> <li> <a href="/football-development/club-services/developing-your-club/scottish-football-marketing-podcast/">Scottish Football Marketing Podcast</a> </li> </ul> </li> <li> <a href="/football-development/club-services/teamworks/">Teamworks</a> </li> <li> <a href="/football-development/club-services/club-accreditation/">Club Accreditation</a> <ul class="dropdown-menu"> <li> <a 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/> <input type="hidden" id="hiddenSubmitMessage" name="hiddenSubmitMessage" value="Thank you for submitting your discrimination report. This will now be looked into." /> <div class="umbraco-forms-page full-page-form"> <h4 class="umbraco-forms-caption">Report The Incident Here</h4> <fieldset class="umbraco-forms-fieldset" id="00000000-0000-0000-0000-000000000000"> <legend>About You</legend> <div class="umbraco-forms-container"> <div class="form-group umbraco-forms-field yourname shortanswer" > <div class="hover-label-wrapper"> <label for="c941eca7-837b-4849-87e6-ec52348fbfc9" class="hover-label"> Your Name </label> <input type="text" name="c941eca7-837b-4849-87e6-ec52348fbfc9" id="c941eca7-837b-4849-87e6-ec52348fbfc9" class="form-control text" value="" maxlength="500" /> </div> <span class="field-validation-valid" data-valmsg-for="c941eca7-837b-4849-87e6-ec52348fbfc9" data-valmsg-replace="true"></span> </div> <div class="form-group umbraco-forms-field youraddress longanswer alternating" > <div class="hover-label-wrapper"> <label for="16d7f88b-fcad-464d-b7bc-97b68d6936e4" class="hover-label"> Your Address </label> <textarea name="16d7f88b-fcad-464d-b7bc-97b68d6936e4" id="16d7f88b-fcad-464d-b7bc-97b68d6936e4" rows="3" cols="20" class="form-control" ></textarea> </div> <span class="field-validation-valid" data-valmsg-for="16d7f88b-fcad-464d-b7bc-97b68d6936e4" data-valmsg-replace="true"></span> </div> <div class="form-group umbraco-forms-field yourpostcode shortanswer" > <div class="hover-label-wrapper"> <label for="33b89f60-5403-44f3-bb29-1b907f5224ca" class="hover-label"> Your Postcode </label> <input type="text" name="33b89f60-5403-44f3-bb29-1b907f5224ca" id="33b89f60-5403-44f3-bb29-1b907f5224ca" class="form-control text" value="" maxlength="500" /> </div> <span class="field-validation-valid" data-valmsg-for="33b89f60-5403-44f3-bb29-1b907f5224ca" data-valmsg-replace="true"></span> </div> <div class="form-group umbraco-forms-field yourtelephonenumber shortanswer alternating" > <div class="hover-label-wrapper"> <label for="7259baad-caa7-46a3-b506-1ced1e749b47" class="hover-label"> Your Telephone Number </label> <input type="text" name="7259baad-caa7-46a3-b506-1ced1e749b47" id="7259baad-caa7-46a3-b506-1ced1e749b47" class="form-control text" value="" maxlength="500" /> </div> <span class="field-validation-valid" data-valmsg-for="7259baad-caa7-46a3-b506-1ced1e749b47" data-valmsg-replace="true"></span> </div> <div class="form-group umbraco-forms-field youremailaddress shortanswer" > <div class="hover-label-wrapper"> <label for="190d2645-1fe3-45f7-8efb-b6098f976b23" class="hover-label"> Your Email Address </label> <input type="text" name="190d2645-1fe3-45f7-8efb-b6098f976b23" id="190d2645-1fe3-45f7-8efb-b6098f976b23" class="form-control text" value="" maxlength="500" /> </div> <span class="field-validation-valid" data-valmsg-for="190d2645-1fe3-45f7-8efb-b6098f976b23" data-valmsg-replace="true"></span> </div> <div class="form-group umbraco-forms-field doyouwishtoremainanonymous singlechoice mandatory alternating" > <div class="checklist" id="6f90f601-c21c-4f62-c0ad-894522a8913b"> <label class="checklist-title"> Do you wish to remain anonymous? <span class="umbracoForms-Indicator">*</span> </label> <label class="checkbox-inline"> <input type="radio" name="6f90f601-c21c-4f62-c0ad-894522a8913b" id="6f90f601-c21c-4f62-c0ad-894522a8913b_0" value="Yes" data-val="true" data-val-requiredlist="Please provide a value for Do you wish to remain anonymous?" /> <span><i class="fa fa-check"></i></span> Yes </label> <label class="checkbox-inline"> <input type="radio" name="6f90f601-c21c-4f62-c0ad-894522a8913b" id="6f90f601-c21c-4f62-c0ad-894522a8913b_1" value="No" data-val="true" data-val-requiredlist="Please provide a value for Do you wish to remain anonymous?" /> <span><i class="fa fa-check"></i></span> No </label> <p class="help-block">All complaints have the choice as to whether they wish their report to be made anonymous. Contact details are taken so the Scottish FA can report back on how the Affiliated National Association has responded to the complaint. Affiliated National Association may wish to contact you if they require any further information or to support any disciplinary cases. If you have chosen to remain anonymous your contact details will not be passed on to the Affiliated National Association.</p> </div> <span class="field-validation-valid" data-valmsg-for="6f90f601-c21c-4f62-c0ad-894522a8913b" data-valmsg-replace="true"></span> </div> </div> </fieldset> <fieldset class="umbraco-forms-fieldset" id="084b8d5c-3d79-472a-fa04-6341419944f7"> <legend>Incident Details</legend> <div class="umbraco-forms-container"> <div class="form-group umbraco-forms-field affiliatedassociationinwhichtheincidenthappened dropdown mandatory" > <div class="select-wrapper alt"> <select name="0e083e99-bc2d-410b-ca3a-55081ba9284e" id="0e083e99-bc2d-410b-ca3a-55081ba9284e" data-val="true" data-val-required="Please provide a value for Affiliated Association in which the incident happened" > <option value="">Select Affiliated Association in which the incident happened ...</option> <option value="East of Scotland" > East of Scotland </option> <option value="Scottish Amateur Football Association" > Scottish Amateur Football Association </option> <option value="Scottish Junior Football Association" > Scottish Junior Football Association </option> <option value="Scottish Para-Football" > Scottish Para-Football </option> <option value="Scottish Schools Football Association" > Scottish Schools Football Association </option> <option value="Scottish Welfare Football Association" > Scottish Welfare Football Association </option> <option value="Scottish Women's Football" > Scottish Women's Football </option> <option value="Scottish Youth Football Association" > Scottish Youth Football Association </option> <option value="South of Scotland" > South of Scotland </option> <option value="West of Scotland" > West of Scotland </option> </select> </div> <span class="field-validation-valid" data-valmsg-for="0e083e99-bc2d-410b-ca3a-55081ba9284e" data-valmsg-replace="true"></span> </div> <div class="form-group umbraco-forms-field leagueinwhichtheincidenthappened shortanswer mandatory alternating" > <div class="hover-label-wrapper"> <label for="9ce314e6-b21d-4b52-bc7e-8cb72b656bc8" class="hover-label"> League in which the incident happened <span class="umbracoForms-Indicator">*</span> </label> <input type="text" name="9ce314e6-b21d-4b52-bc7e-8cb72b656bc8" id="9ce314e6-b21d-4b52-bc7e-8cb72b656bc8" class="form-control text" value="" maxlength="500" data-val="true" data-val-required="Please provide a value for League in which the incident happened" /> </div> <span class="field-validation-valid" data-valmsg-for="9ce314e6-b21d-4b52-bc7e-8cb72b656bc8" data-valmsg-replace="true"></span> </div> <div class="form-group umbraco-forms-field agegroupofplayers dropdown mandatory" > <div class="select-wrapper alt"> <select name="259a4afc-399b-4658-f121-edcf2dbde346" id="259a4afc-399b-4658-f121-edcf2dbde346" data-val="true" data-val-required="Please provide a value for Age group of players" > <option value="">Select Age group of players ...</option> <option value="Under-12" > Under-12 </option> <option value="12-18 Years" > 12-18 Years </option> <option value="Over 18 Years" > Over 18 Years </option> </select> </div> <span class="field-validation-valid" data-valmsg-for="259a4afc-399b-4658-f121-edcf2dbde346" data-valmsg-replace="true"></span> </div> <div class="form-group umbraco-forms-field fixtureinwhichtheincidenthappened shortanswer mandatory alternating" > <div class="hover-label-wrapper"> <label for="54c1851e-ed9c-44d9-d2ec-202da37e35c9" class="hover-label"> Fixture in which the incident happened <span class="umbracoForms-Indicator">*</span> </label> <input type="text" name="54c1851e-ed9c-44d9-d2ec-202da37e35c9" id="54c1851e-ed9c-44d9-d2ec-202da37e35c9" class="form-control text" value="" maxlength="500" data-val="true" data-val-required="Please provide a value for Fixture in which the incident happened" /> </div> <span class="field-validation-valid" data-valmsg-for="54c1851e-ed9c-44d9-d2ec-202da37e35c9" data-valmsg-replace="true"></span> </div> <div class="form-group umbraco-forms-field venueatwhichtheincidenthappened shortanswer mandatory" > <div class="hover-label-wrapper"> <label for="91ffa31e-4ddd-414b-e39b-c59fffa8ed5c" class="hover-label"> Venue at which the incident happened <span class="umbracoForms-Indicator">*</span> </label> <input type="text" name="91ffa31e-4ddd-414b-e39b-c59fffa8ed5c" id="91ffa31e-4ddd-414b-e39b-c59fffa8ed5c" class="form-control text" value="" maxlength="500" data-val="true" data-val-required="Please provide a value for Venue at which the incident happened" /> </div> <span class="field-validation-valid" data-valmsg-for="91ffa31e-4ddd-414b-e39b-c59fffa8ed5c" data-valmsg-replace="true"></span> </div> <div class="form-group umbraco-forms-field dateoftheincident date mandatory alternating" > <div class="hover-label-wrapper"> <label for="4add877f-c50a-4309-8a40-89deffabb0a1_1" class="hover-label"> Date of the incident <span class="umbracoForms-Indicator">*</span> </label> <div class="date-picker"> <input type="hidden" name="4add877f-c50a-4309-8a40-89deffabb0a1" id="4add877f-c50a-4309-8a40-89deffabb0a1" class="datepickerfieldshadow" value="" /> <input class="form-control datepickerfield default-datepicker" autocomplete="off" onkeypress="return false;" name="4add877f-c50a-4309-8a40-89deffabb0a1" id="4add877f-c50a-4309-8a40-89deffabb0a1_1" type="text" value="" data-val="true" data-val-required="Please provide a value for Date of the incident" /> <span class="date-picker-icon"><i class="fa fa-calendar"></i></span> </div> </div> <span class="field-validation-valid" data-valmsg-for="4add877f-c50a-4309-8a40-89deffabb0a1" data-valmsg-replace="true"></span> </div> <div class="form-group umbraco-forms-field whatisyourpositionatyourclub shortanswer mandatory" > <div class="hover-label-wrapper"> <label for="2a5c32dd-0e28-4874-9eb9-86986f18001b" class="hover-label"> What is your position at your club? <span class="umbracoForms-Indicator">*</span> </label> <input type="text" name="2a5c32dd-0e28-4874-9eb9-86986f18001b" id="2a5c32dd-0e28-4874-9eb9-86986f18001b" class="form-control text" value="" maxlength="500" data-val="true" data-val-required="Please provide a value for What is your position at your club?" /> </div> <span class="field-validation-valid" data-valmsg-for="2a5c32dd-0e28-4874-9eb9-86986f18001b" data-valmsg-replace="true"></span> </div> </div> </fieldset> <fieldset class="umbraco-forms-fieldset" id="8d74ae41-f7da-4bac-97d6-acc3bdbc84db"> <legend>The Incident</legend> <div class="umbraco-forms-container"> <div class="form-group umbraco-forms-field wereyouthevictimoftheabuseifnotpleasedescribewhowas longanswer mandatory alternating" > <div class="hover-label-wrapper"> <label for="fd19b48e-0d7f-4ac7-bde3-dd148be1a81d" class="hover-label"> Were you the victim of the abuse, if not please describe who was? <span class="umbracoForms-Indicator">*</span> </label> <textarea name="fd19b48e-0d7f-4ac7-bde3-dd148be1a81d" id="fd19b48e-0d7f-4ac7-bde3-dd148be1a81d" rows="3" cols="20" class="form-control" data-val="true" data-val-required="Please provide a value for Were you the victim of the abuse, if not please describe who was?" ></textarea> </div> <span class="field-validation-valid" data-valmsg-for="fd19b48e-0d7f-4ac7-bde3-dd148be1a81d" data-valmsg-replace="true"></span> </div> <div class="form-group umbraco-forms-field pleaseprovideasmanydetailsaspossibleincludingtimeofincidentwhatwassaidnamesofthoseinvolved longanswer mandatory" > <div class="hover-label-wrapper"> <label for="4f9791cb-8ea7-4cbf-9032-ff12b7cddcc8" class="hover-label"> Please provide as many details as possible including time of incident, what was said, names of those involved <span class="umbracoForms-Indicator">*</span> </label> <textarea name="4f9791cb-8ea7-4cbf-9032-ff12b7cddcc8" id="4f9791cb-8ea7-4cbf-9032-ff12b7cddcc8" rows="3" cols="20" class="form-control" data-val="true" data-val-required="Please provide a value for Please provide as many details as possible including time of incident, what was said, names of those involved" ></textarea> </div> <span class="field-validation-valid" data-valmsg-for="4f9791cb-8ea7-4cbf-9032-ff12b7cddcc8" data-valmsg-replace="true"></span> </div> <div class="form-group umbraco-forms-field descriptionofoffenderifknown longanswer mandatory alternating" > <div class="hover-label-wrapper"> <label for="66b4253f-4cca-44a1-82ae-77036beb4d10" class="hover-label"> Description of offender (if known) <span class="umbracoForms-Indicator">*</span> </label> <textarea name="66b4253f-4cca-44a1-82ae-77036beb4d10" id="66b4253f-4cca-44a1-82ae-77036beb4d10" rows="3" cols="20" class="form-control" data-val="true" data-val-required="Please provide a value for Description of offender (if known)" ></textarea> </div> <span class="field-validation-valid" data-valmsg-for="66b4253f-4cca-44a1-82ae-77036beb4d10" data-valmsg-replace="true"></span> </div> <div class="form-group umbraco-forms-field wherewasweretheoffenderspositioned longanswer mandatory" > <div class="hover-label-wrapper"> <label for="e2452525-dd38-417b-866c-736e99deb815" class="hover-label"> Where was (were) the offender(s) positioned <span class="umbracoForms-Indicator">*</span> </label> <textarea name="e2452525-dd38-417b-866c-736e99deb815" id="e2452525-dd38-417b-866c-736e99deb815" rows="3" cols="20" class="form-control" data-val="true" data-val-required="Please provide a value for Where was (were) the offender(s) positioned" ></textarea> </div> <span class="field-validation-valid" data-valmsg-for="e2452525-dd38-417b-866c-736e99deb815" data-valmsg-replace="true"></span> </div> <div class="form-group umbraco-forms-field wasanyoneinjured longanswer alternating" > <div class="hover-label-wrapper"> <label for="48a6b859-83eb-43b3-a514-041384184051" class="hover-label"> Was anyone injured? </label> <textarea name="48a6b859-83eb-43b3-a514-041384184051" id="48a6b859-83eb-43b3-a514-041384184051" rows="3" cols="20" class="form-control" ></textarea> </div> <span class="field-validation-valid" data-valmsg-for="48a6b859-83eb-43b3-a514-041384184051" data-valmsg-replace="true"></span> </div> <div class="form-group umbraco-forms-field didanylossordamagetopropertyresultfromtheincident longanswer" > <div class="hover-label-wrapper"> <label for="31090ed1-60d2-488b-84ef-596272c936a0" class="hover-label"> Did any loss or damage to property result from the incident? </label> <textarea name="31090ed1-60d2-488b-84ef-596272c936a0" id="31090ed1-60d2-488b-84ef-596272c936a0" rows="3" cols="20" class="form-control" ></textarea> </div> <span class="field-validation-valid" data-valmsg-for="31090ed1-60d2-488b-84ef-596272c936a0" data-valmsg-replace="true"></span> </div> <div class="form-group umbraco-forms-field couldyouidentifythepersonagain singlechoice alternating" > <div class="checklist" id="2c142991-7ead-4f56-f7a2-af90745018e1"> <label class="checklist-title"> Could you identify the person again? </label> <label class="checkbox-inline"> <input type="radio" name="2c142991-7ead-4f56-f7a2-af90745018e1" id="2c142991-7ead-4f56-f7a2-af90745018e1_0" value="Yes" /> <span><i class="fa fa-check"></i></span> Yes </label> <label class="checkbox-inline"> <input type="radio" name="2c142991-7ead-4f56-f7a2-af90745018e1" id="2c142991-7ead-4f56-f7a2-af90745018e1_1" value="No" /> <span><i class="fa fa-check"></i></span> No </label> </div> <span class="field-validation-valid" data-valmsg-for="2c142991-7ead-4f56-f7a2-af90745018e1" data-valmsg-replace="true"></span> </div> <div class="form-group umbraco-forms-field werethereanyotherwitnessestotheincidentifsostatewho longanswer" > <div class="hover-label-wrapper"> <label for="75d9a299-c35e-4e3d-c23b-0dd62a211f6a" class="hover-label"> Were there any other witnesses to the incident? (if so, state who) </label> <textarea name="75d9a299-c35e-4e3d-c23b-0dd62a211f6a" id="75d9a299-c35e-4e3d-c23b-0dd62a211f6a" rows="3" cols="20" class="form-control" ></textarea> </div> <span class="field-validation-valid" data-valmsg-for="75d9a299-c35e-4e3d-c23b-0dd62a211f6a" data-valmsg-replace="true"></span> </div> </div> </fieldset> <fieldset class="umbraco-forms-fieldset" id="22d3f239-e8b9-4edc-91d3-d866ab20a7ad"> <legend>Additional Information</legend> <div class="umbraco-forms-container"> <div class="form-group umbraco-forms-field wasthematchrefereemadeawareoftheincident singlechoice alternating" > <div class="checklist" id="288176b2-7e64-4f4e-edb7-2863baba6dca"> <label class="checklist-title"> Was the match referee made aware of the incident? </label> <label class="checkbox-inline"> <input type="radio" name="288176b2-7e64-4f4e-edb7-2863baba6dca" id="288176b2-7e64-4f4e-edb7-2863baba6dca_0" value="Yes" /> <span><i class="fa fa-check"></i></span> Yes </label> <label class="checkbox-inline"> <input type="radio" name="288176b2-7e64-4f4e-edb7-2863baba6dca" id="288176b2-7e64-4f4e-edb7-2863baba6dca_1" value="No" /> <span><i class="fa fa-check"></i></span> No </label> </div> <span class="field-validation-valid" data-valmsg-for="288176b2-7e64-4f4e-edb7-2863baba6dca" data-valmsg-replace="true"></span> </div> <div class="form-group umbraco-forms-field didthematchofficialstakeanyactioninresponse longanswer mandatory" > <div class="hover-label-wrapper"> <label for="fb53a4b0-a237-4063-d20d-46fde6b262cd" class="hover-label"> Did the match officials take any action in response? <span class="umbracoForms-Indicator">*</span> </label> <textarea name="fb53a4b0-a237-4063-d20d-46fde6b262cd" id="fb53a4b0-a237-4063-d20d-46fde6b262cd" rows="3" cols="20" class="form-control" data-val="true" data-val-required="Please provide a value for Did the match officials take any action in response?" ></textarea> </div> <span class="field-validation-valid" data-valmsg-for="fb53a4b0-a237-4063-d20d-46fde6b262cd" data-valmsg-replace="true"></span> </div> <div class="form-group umbraco-forms-field wereanyotherclubofficialsmadeawareoftheincident singlechoice mandatory alternating" > <div class="checklist" id="b2df0e25-bc81-41cb-eae1-8bbab41398c1"> <label class="checklist-title"> Were any other club officials made aware of the incident? <span class="umbracoForms-Indicator">*</span> </label> <label class="checkbox-inline"> <input type="radio" name="b2df0e25-bc81-41cb-eae1-8bbab41398c1" id="b2df0e25-bc81-41cb-eae1-8bbab41398c1_0" value="Yes" data-val="true" data-val-requiredlist="Please provide a value for Were any other club officials made aware of the incident?" /> <span><i class="fa fa-check"></i></span> Yes </label> <label class="checkbox-inline"> <input type="radio" name="b2df0e25-bc81-41cb-eae1-8bbab41398c1" id="b2df0e25-bc81-41cb-eae1-8bbab41398c1_1" value="No" data-val="true" data-val-requiredlist="Please provide a value for Were any other club officials made aware of the incident?" /> <span><i class="fa fa-check"></i></span> No </label> </div> <span class="field-validation-valid" data-valmsg-for="b2df0e25-bc81-41cb-eae1-8bbab41398c1" data-valmsg-replace="true"></span> </div> <div class="form-group umbraco-forms-field havethepolicebeeninformedoftheincident singlechoice mandatory" > <div class="checklist" id="7e0326da-655d-42a3-d073-d53cd05e6b5b"> <label class="checklist-title"> Have the police been informed of the incident? <span class="umbracoForms-Indicator">*</span> </label> <label class="checkbox-inline"> <input type="radio" name="7e0326da-655d-42a3-d073-d53cd05e6b5b" id="7e0326da-655d-42a3-d073-d53cd05e6b5b_0" value="Yes" data-val="true" data-val-requiredlist="Please provide a value for Have the police been informed of the incident?" /> <span><i class="fa fa-check"></i></span> Yes </label> <label class="checkbox-inline"> <input type="radio" name="7e0326da-655d-42a3-d073-d53cd05e6b5b" id="7e0326da-655d-42a3-d073-d53cd05e6b5b_1" value="No" data-val="true" data-val-requiredlist="Please provide a value for Have the police been informed of the incident?" /> <span><i class="fa fa-check"></i></span> No </label> </div> <span class="field-validation-valid" data-valmsg-for="7e0326da-655d-42a3-d073-d53cd05e6b5b" data-valmsg-replace="true"></span> </div> <div class="form-group umbraco-forms-field anyotherinformation longanswer alternating" > <div class="hover-label-wrapper"> <label for="0e1c4383-1d07-479c-a4cc-7fb313a9ed10" class="hover-label"> Any other information? 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