Incident Report

If something happens on our premises, whether it was an injury or someone felt uncomfortable, we want to know about it.

To file a formal complaint, please fill out this form completely. If you need help completing the form, or want to discuss the issue before completing the form, please contact the owner at 917-631-3165 or info@lifelongsportstraining.com.

Please know that the information you submit will be held in confidence until you meet with the owner to discuss the process that will be followed to investigate and resolve the situation (except when in doing so results in a danger to other participants). Additionally, participants will never be required to confront the person accused.

Name of person completing this form

Email for person completing this form

Phone number for person completing this form

Relationship to participant

Participant name

Date of the incident?

Describe the circumstances causing your report.

Be specific with details, times, location, etc.

Describe any efforts you made to resolve your incident and the response received to your efforts.

ie who did you speak to when it happened? were you seen by a doctor or hospitalized?

Describe the outcome or remedy you seek for this incident (if applicable).

Additional notes and information

Incident Report

Lifelong Sports

FACILITY INFORMATION

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