Maltreatment Report (St Catharines CYO Minor Hockey)

ALLIANCE HOCKEY Digital Network

Maltreatment Report
NOTE THAT THIS INTAKE FORM IS TO BE USED TO ADDRESS INCIDENTS OF DISCRIMINATION ONLY. For other type of complaints, including those relating to maltreatment, abuse, bullying, harassment, or any other negative treatment which does *not* contain an element of discrimination, please use the INCIDENT REPORT form located in the forms section of this website.

Contact Information

The person who is filing the complaint is asked to complete the following information.

Person on whose behalf the claim is being made

Please complete this section if filing this complaint on someone else's behalf.

Who is the complaint against?

Please list the names and information of who the complaint is being filed against.

Incident Date

Incident Information

‘Discrimination’ is an action or a decision that treats a person or a group differently or unfairly because of certain protected personal characteristics. These characteristics, also called grounds, are protected under human rights legislation. Discriminatory grounds vary by province but generally include the following, without limitation: (a) Race, national or ethnic origin, skin colour, language spoken; (b) Religion, faith, or beliefs; (c) Age; (d) Sex, sexual orientation, or gender identity/expression; (e) Marital or familial status; (f) Genetic characteristics (g) Disability. Discrimination occurs when the unique merits, capacities, and circumstances of a person are not individually assessed. Instead, the party who is guilty of discrimination makes stereotypical assumptions based on a person’s presumed traits and then treats them accordingly. Discrimination often has the impact of excluding persons, denying them benefits, or imposing burdens on them.

Incident Report

Please provide a detailed and accurate summary outlining the particulars of the incident to support your compliant. In your summary, please ensure your responses provide commentary to the following questions --- Where did the incident occur? Who was involved in the incident? (Provide name, title, position) Describe details of the incident in order of occurrence to the best of your ability. What happened? How were you treated? Identify any witness(es) that may support your complaint (name, position, title, what was their involvement (participant vs. observer) if any and where were they positioned at the time the incident occurred. How does the incident(s) align to the ground(s) you selected? Are any witnesses willing to speak to us?