Please give us your full name, you will get the opportunity later to tell us if you wish this to be disclosed to the complainee.

Please complete your address details including postcode.

Please also let us have your email for contact purposes, including confirming receipt of your complaint.

We may need to contact you in relation to this complaint so please let us know your best contact phone number.

Please let us know of any football roles you currently hold.

Please confirm the organisation that you are complaining about. If this is the Shropshire FA, Shropshire FA staff or member, please indicate in next box below

If your complaint is against a specific person, please state their name below. If this is a club or league, please state the organisation name.

Please give as many details as possible if you do not know the person's name, and also state what role they had when you interacted with them.

Please provide full details of the complaint you wish to make, please be as descriptive and factual as you can. If there was any foul language used please write this in full and don't star out any letters or words.

Please also indicate the date, time and location that this incident took place, and whether you were interacting in person or on the telephone or by some other means.

If you don't have enough space ,or wish to add further supporting statements or photo evidence, you will have the opportunity to upload files at the end of the form.

Please indicate your desired outcome of this complaint. This may take the form of an apology, a change in the procedure at Shropshire FA, or an alternative option. If you are unsure of the outcome you desire, please state this

Please list the full names and email addresses of any other witnesses that are happy for us to contact them in relation to this complaint.