The American Legion National Headquarters
REPORTING FORM
CHILD ABUSE / SUSPECTED CHILD ABUSE
This section is about the individual you are reporting. Please provide as much information as possible.
INDIVIDUAL
Name of the individual you are reporting (first and last)
Age or approximate age
Gender◻ Male ◻ Female
Street Address
City
State
ZIP
Program position(s) this individual held at time of the incident
This section asks questions about the incident(s) you are reporting. Please provide as much information as possible.
INCIDENT(S)
Type of offense (e.g., what is being suspected or alleged)
During which national youth program did the incident(s) take place?
What is the location of where the incident(s) took place? (include city, state and any other available location information)
Street Address
City
State
ZIP
Other location information
Describe what happened (include who, what, when, where) (continue on reverse side if necessary)
2021 AMERICAN LEGION BASEBALL RISK MANAGEMENT GUIDEBOOK 19
This section is for information about the victim(s).
VICTIM(S)
Name (first and last)
Age or approximate age
Gender◻ Male ◻ Female
Parent/Guardian name
Parent/Guardian Address
City
State
ZIP
Parent/Guardian phone numbers
Cell
Home
This section is your information. A person reporting alleged misconduct should not fear any retribution and/or consequence when filing a report, he/she believes to be true.
YOUR INFORMATION
Name (first and last)
Email address
Cell
Home Phone
Address
City
State
ZIP
Program position you were holding at time of the incident
Relationship to victim (if any)
It is strongly urged and recommended that respective American Legion departments and/or Team Sponsors implement use of this written report form entitled “REPORTING FORM”, and after having immediately contacted law enforcement authorities and parent(s)/guardian(s) in cases involving child abuse or suspected child abuse, the Reporter then offer a copy of this completed form to law enforcement authorities, and provide a copy to the respective American Legion department baseball chairman
and/or Team Sponsor, if considered necessary. All information regarding alleged child abuse must be maintained under strict confidentiality and communicated only to those having a “need-to-know”.
In the event of a report, the department baseball chairman is responsible to notify the appropriate parties at The American Legion’s National Headquarters to the attention of the Americanism Division