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Concern Regarding Clergy, Staff, or Volunteer Leader of IAC
Thank you for joining IAC in our pursuit of creating a Holistically Safe community for the sake of the gospel. 

By completing this form, within our Anglican structure, you are making a direct report concerning a member of our clergy, staff, or volunteer leader at IAC, and said report will go directly to Pastor Ken Robertson and Warden Danielle Mellema.

Please know that IAC will act on your report. Should you have questions or desire to speak with someone about your report, please email warden@springsiac.org.

Should you choose to report anonymously, we will not be able to respond or reach out directly to you. 
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Name:
(Should you desire to report anonymously, please write "Anonymous.")
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Email:
(Should you desire to report anonymously, please write "Anonymous.")
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Phone Number:
(Should you desire to report anonymously, please write "Anonymous.")
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Statement of Concern Regarding Clergy, Staff, or Volunteer Leader of IAC: 

Please note these items, to the best of your ability and memory, in addition to any other information you feel would be important to share:

-Time, Date, Location of Incident

-Person who experienced this incident, if it was not you.

-Other Clergy, Staff or Volunteer Leader who were present, if any.

-Specific Description of how Holistic Safety was compromised. or a policy not upheld.
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Thank you. 
We know that completing this report may have been challenging, triggering, and/or you may have experienced a felt reoccurrence of hurt or harm. We would encourage you to process this with a safe person, through counseling or pastoral care. 

You can always contact care@springsiac.org to request a confidential meeting with a pastor that remains safe to you or to request financial support to pursue counseling outside of IAC.

Thank you for letting us hear you and begin to respond. 
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