Anonymous Reporting

The Cumberland Cape Atlantic YMCA takes child protection seriously.  We have a Zero Tolerance Policy for inappropriate behavior.  Please feel free to complete this form to report the incident you witnessed.  All reports are kept confidential.

Thank you,
Theresa Booth, MAT, M.Ed., C-PG
Senior Director of Child Development
Praesidium Guardian

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* 1. Individual Filing the Complaint (optional)

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* 2. Date of Occurrence

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* 3. Time of Occurrence

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* 4. Other Individuals Involved/Witness to the Complaint

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* 5. Type of Complaint (select all that apply)

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* 6. Location of Incident

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* 7. Describe the situation
What happened, where it happened, when it happened, who was involved, who was present, who was notified?  If suspected abuse, was it reported to the Police or State?

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* 8. Has the situation ever occurred previously? 

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* 9. Describe the remedy you seek.
Please list all remedies sought as a result of bringing this grievance.  What would you like to see happen to solve this issue?

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