The Swim England Wavepower referral form

Please note all fields marked with a * are mandatory. All other fields are optional.

Details of referrer (your details)

Name of Organisation *

Name of referrer *

First

Last

Position in the Organisation *

Your phone *

Your email *

How many children / victims are concerned?

Please fill out the details regarding the people this allegation is being made against.

How many adults / children is the allegation made against?

Person 2

LADO Telephone number (if known)

Was medical assistance required? *

Yes
No

Were the parents informed? *

Yes
No

Details of action taken *

If you have any additional reports or supporting documents please email them to safeguardingreferralform@swimming.org.

The safeguardingreferralform@swimming.org address is only for referral forms and any supporting information.

If you need any further advice or guidance please contact the safeguarding team on 01509 640700 (Option 1 for Swim England and then Option 5 for Safeguarding) .

Signature *

Date *

Email *

Details of referrer (your details)

Child / Victim 1

Child / Victim 2

Child / Victim 3

Child / Victim 4

Child / Victim 5

Person 1

Person 2

Person 3

Person 4

Person 5

Incident / concern details

Action taken by the organisation