Youth Witness Statement Form

Youth Witness Statement Form

This form is designed to be used by anyone under the age of 18.

We encourage you to be with an adult or your clubs welfare officer when completing this form so they can help you if needed.

We will use the information you provide to help us with our investigation and it may be used in evidence to charge a participant.

Declaration

All the information I am about to give is true and I understand it may be used as evidence. If needed, I would be happy to attend a hearing along with a parent / guardian / responsible adult

I confirm that this is true*

I would be happy to share and have my parent / guardian contacted regarding this information by other partners*

If relevant my parent / guardian would be happy to share the information provided with our Inclusion Advisory Group for further support, the University of Leicester for research or other agencies.

Yes

Your details

What is your name?*

Let us know your first name and second name

How old are you?*

This form should only be used if you are under the age of 18 years old. If you are 18 or over please complete this form instead

What is your Parent / Guardians Email address?*

Why were you at this game?*

Player

What Club are you with?*

Incident details

What date did this happen?*

What team were you playing against?*

Person(s) Involved

What can you tell us about the person you are reporting*

This could be a name, shirt number, or what they looked like

Incident Witnessed

Tell us what happened*

Write down as much detail as you can about what happened. Try and think about what you saw and heard. If you heard somebody say something, try and remember the exact words they used and put them in "speech marks"

How far away were you and could you see it clearly?*

As an example: I stood about 10 meters away looking towards the corner flag, no one was stood in my way

Did you tell anyone about this?*

Let us know who you spoke to about it and when you did this

What would you like to happen next?*

Please be aware this is the County FA's choice as to what happens next, but we will let you know the outcome.

Select

Send me a copy of my responses

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