The opportunity for boys and girls of Moorestown, NJ to learn and enjoy lacrosse.

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                     MOORESTOWN LACROSSE CLUB -GRIEVANCE FORM

1.      Date of Incident:           ___________________________________________________

2.      Approximate Time of Incident: ______________________________________________

3.      Location of Incident: ______________________________________________________

4.      Teams/Clubs present: ______________________________________________________

5.      Person/(s) Initiating Grievance: ______________________________________________

6.      Phone # of above: (home) ___________________   (cell) _________________________

7.      E-mail address of above: ___________________________________________________

8.      Person(s) Against Whom Grievance is Initiated: _________________________________ _________________________________
_________________________________

9.      Description of  Incident (include specific Code of Conduct provision violated):  _________________________________________________________________________
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10.  Witness(es): ____________________________________________________________           
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11.  Were the Police Called?              ____ No                   ____ Yes  If yes, explain _________________________________________________________________________
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12.  Other Pertinent Information:  _______________________________________________
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13.  Signature(s) of person(s) filing the grievance:              ___________________________________Date:______________________
___________________________________Date:______________________
___________________________________Date:______________________
___________________________________Date:______________________

         (Submit the completed grievance form to the appropriate Program Vice President (VP Boys Program or VP Girls Program).