Ipswich Basketball - Formal Complaint
Complaints MUST be lodged within 48 hours of the incident occurring.
Name
*
First Name
Last Name
Mobile number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Date of incident
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Time of incident
*
Hour Minutes
AM
PM
AM/PM Option
I am a:
*
Please Select
Player
Referee
Referee Supervisor
Court Controller
Parent
Coach
None of the Above
What is your teams name?
What club are you associated with?
*
Please Select
Tigers Basketball Club
Brothers
Swifts Comets Basketball Club
Mt Crosby Basketball Club
Central Bulldogs
IGS
Ripley Valley Thunder
Springfield Brumbies
No Club
Complaint Type:
*
Officiating
Abuse/Behaviour
Administration
Coach/Bench
Scorebench
Spectator
Bullying
Other
Team A Name:
Team B Name:
Court Number:
*
Age Group and Division (e.g. U16 Boys – Division 1)
Referee name(s), if known:
Please provide a detailed description of your complaint, including all relevant information and circumstances.
*
At the time of the incident, did you speak to anyone? If yes, please provide their name(s) and any relevant details.
*
Have the actions you are lodging this complaint about occurred previously? If yes, please provide details.
Please describe how the situation made you feel, and note any physical, emotional or practical impacts.
Do you believe the actions of the person(s) involved were unlawful, unfair, unjustified, or in breach of the Basketball Australia Member Protection Policy? If yes, please explain why and provide any supporting details.
*
How do you believe this situation could be resolved? Please outline any actions or outcomes you feel would be appropriate.
*
Would you like a formal response from IBA?
*
Yes
No
Signature
Submit
Should be Empty: