Incident Report Form

Person(s) Affected by this incident:

Please provide the following information on Affected Person(s): First & Last Name, Gender, Age, The affected person is a: camper, staff, visitor, volunteer, or staff family member, Address, City, State, Parent/Guardian (for minors), Phone number of affected person.

Alleged Perpetrator(s)

Please provide the following information on Alleged Perpetrator(s): First & Last Name, Gender, Age, he alleged perpetrator is a: camper, staff, visitor, volunteer, or staff family member, Address, City, State, Parent/Guardian (for minors), Phone number of alleged perpetrator(s).

Incident Description

Incident Witnesses/Other Parties:

%d bloggers like this: