Report an Incident

Please Download and fill out an Incident Response Form.
Once it is filled out, please return it to the LSC Clubhouse, the Blondin Building at the 7th Ave Soccer Fields, or scan and e-mail to Jeff Coleman.
If it is easier for you, please fill out and submit this Incident Report form online.  If you have any photographs, scans or other documents that you would like to include with this, please send them to Jeff Coleman
CYSA Incident Report
 Report Submitted By:  
 Contact Phone Number:  
 Contact Email  
 Date: *  
 Person(s) involved, and if known, include the name of the team or club the peron(s) is/are associated with: *
 Date of Incident:: *  
 Nature of Incident, please check all that apply:
Inappropriate Conduct
Violation of CYSA, WSYSA, USSF rules or policies
Violation of CYSA or member club property
Negative impact on players
Other (please note in description)
 Description of Incident: *
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