TJYCA Grievance Form
Please utilize this form if you wish to file a formal complaint to TJYCA. This form must be filled out accurately, and fully before submitting. Please allow Board Members to investigate all complaints, a Board member will reach out to you if we need more information is needed than what was originally provided. We will alert you when our investigation has concluded and our outcome/resolution of the original complaint is reached.
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Parent or Guardian Name: *
Parent or Guardian's Home Address: *
Parent or Guardian's Best Phone Number for Contact:
Parent or Guardian's Best Email Address for Contact: *
Child's Grade: *
Head Coaches Name: *
WHO WAS INVOLVED?
Provide names and Include witnesses. *
WHEN DID IT OCCUR?
Date and time
 *
WHERE DID IT OCCUR?
Specific locations
 *
WHAT HAPPENED?
Describe the event in detail. Also, describe
any incidents giving rise
to the grievance. 
 *

ADDITONAL COMMENTS:

Please place your Full Legal Name in the box below: This signature certifies that you are formally submitting a complaint to the TJYCA organization. This signature also certifies that the TJYCA can reach out to you in regards to this complaint/grievance for our records. *
Date Formal Complaint/Grievance is being filed: *
MM
/
DD
/
YYYY
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