LaPlata Blue Knights Football
and Cheerleading Organization
P.O. Box 956
LaPlata, MD 20646
www.lpbk.com

Grievance Form

                                         Date of Application:_________

Person Filing Complaint: ____Player ____Parent 
                                       ____Coach ____Other

Phone Number (s):_____________________________________

Person Filing Complaint is Affiliated with: ____Football 
                                                                 ____Cheerleading

Please state Team pound or squad:________________________

Offender’s Name:______________________________________

___Player ___Parent ___Coach ___Board Member _________________Other (please specify)

Date Offense Occurred:____________________

Location of Offense:_______________________

Provide Detailed Description of Event:
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Desired Outcome or Suggested Solution for Grievance:

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X__________________________________  _______________

Signature                                                         Date

LPBK Form # 109 Revised 10.7.07