Derby United - Grievance Form
This form is for documentation of an incident to the Roller Derby 360 Internal Relations Department. A grievance may document a violation of the Code of Conduct or may be a communication or behavior that a member felt was in violation of our guiding principles of athleticism, empowerment, inclusion and respect. The department will review your grievance and follow up with the Reporting Member.
Reporting Member's Name (Legal): *
If you wish to remain anonymous, please list "Anonymous" below. You may designate a representative (such as the skater rep or a coach) to handle the grievance communications on your behalf.
Your answer
Reporting Member's Derby Name: *
If you wish to remain anonymous, please list your designated representative (such as the skater rep or a coach) to handle the grievance communications on your behalf below.
Your answer
Team / League Affiliation: *
Your answer
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