Adult Referral Form

Section 1: About this form

All safeguarding and equality questions, concerns or allegations should be shared with RYA Safe Sport Team through this form.

A safeguarding or equality concern could be:

an allegation of abuse or poor practice
being worried that a child or adult may be at risk of harm or may have been harmed
experiencing or witnessing any form of direct or indirect discrimination, harassment or victimisation

Please don’t delay your concern, even if you are unsure whether to report or do not have all the details. The Safe Sport Team will contact you for further information or advice if required.

If a child, young person or adult is at immediate risk of harm, call 999 or 112 and ask for the police.

If you are a child or young person, please use this form.

Information we will ask for in this form is:

Details of person reporting this concern (your details)
Details of concern
Details of those involved in the concern

The Safe Sport Team will receive your form and respond within 5 business days. If your concern is urgent, we will endeavour to respond within 24 hours.

Other ways to contact us

In an emergency call 02380 012796 between 9am and 10pm, 7 days a week including bank holidays.

For general enquiries call 02380 012796 between 9am and 5pm, Monday to Friday.

If you have any problems completing this form, you can contact the RYA Safeguarding team on 02380 604226 / safeguarding@rya.org.uk. For equality referrals you can contact the RYA Equality Team on 02380 604249 / equality@rya.org.uk

Section 2: Details of person reporting this concern

We may need to contact you for more information. Your details will be kept confidential and only shared with those who need to know to respond to the concern.

First Name:

Last Name:

Email:

Tick here if you would like to receive a copy of your report by email.If you choose to receive a copy of the information you have submitted, please double check that you have entered your correct email address in the box above. Please also ensure that the email received is secure and treated as confidential.

Contact No.:

Your role in sport (if relevant):

What is the name of your club?

Please select whether anyone involved in this concern is under 18 or an adult at risk:

Under 18

Adult at Risk

Unsure

Section 3: Details of concern

Type of concern: *

Tell us about your concerns - what has happened to lead you to make this referral? *
Please include as many details as possible: - Who is involved (names and roles, e.g. instructor, coach, another young person or another adult). - What happened - Where it happened (e.g. at the club, at an event, online) - When it happened (date or approximate time) - Whether this has happened before - Whether anyone else saw or heard it

Has anything already been done in relation to this incident? *
For example, if you've already reported to a club or a coach.

Is anyone else aware you are making this referral? *
This could be the parent if the child your concerns are for or your club welfare officer.

Section 4: Details of those involved in concern

This form has not asked for names of individuals to ensure you can consider sharing personal data. We can discuss the details safely with you later if appropriate. Please ensure you provide the correct contact details for yourself so we can obtain further information if required.

Section 5: Data privacy statement/confidentiality statement

The information you are providing in this form will be reviewed by our Safe Sport Team, to determine whether action needs to be taken in line with our Safeguarding policy. The information will be stored securely on our Safe Sport Case Management System, and only appropriate members of the team given access to it. To keep children and adults safe, information may need to be shared appropriately with other entities. We may also contact you, or other people involved to request further information. The information you provide will be used and stored in accordance with the RYAs privacy policy, available at www.rya.org.uk/go/privacy

*The information you have provided on this form will be used for the purposes of recording your concern. The legal basis for processing this information shall be legitimate interest. The information you provide will be used and stored in accordance with the RYAs privacy policy, available at www.rya.org.uk/go/privacy