Philly Dance Safe Spaces Reporting Form
Please report any safe space concerns using the form below. Be aware that no action will be taken based solely on your report without your consent. You have an option to remain anonymous, however please realize that we will not be able to follow-up with you around the incident if contact information is not provided. All reports submitted using this form will remain confidential (based on your request), and only those on the LaB Safe Space team have access to the information submitted.
Date of Incident (if applicable)
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DD
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YYYY
Dance or event where incident occurred *
Your answer
Your Name (optional)
Your answer
Your email address (optional)
Your answer
Your phone number (optional)
Your answer
Nature of the report *
Name(s) and/or description(s) of those involved in the incident
Your answer
Please describe the incident in as much detail as possible *
Your answer
Please describe any actions that have already been taken to address this incident
Your answer
We would love to follow-up with you. Are you OK with us contacting you regarding the incident? *
Required
Which of the following actions are you comfortable with? *
Required
We thank you for taking the time to make our community safer! Is there anything else you would like us to know?
Your answer
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