Witness Statement Form
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1Witness Statement Form
Individual filing grievance:______________________________________________________________________
Name of individual or committee grievance is filed against:____________________________________________
Date of test:___________________________ Type of test (circle one):
Water
Draft
Test-giving club:________________________________________________________________________________
Names of witness completing this form: _____________________________________________________________
Were you an exhibitor at the test in question (circle one)?
Yes
No
Were you a spectator at the test in question (circle one)?
Yes
No
Were you a steward at the test in question (circle one)?
Yes
No
Were you in any other official capacity at the test in question (circle one)?
Yes
No
If yes, what was your official capacity?______________________________________________________
Please write a concise description of the actions you personally witnessed. Do not include information provided to
you by others at the test. Please be as specific as possible when stating names of those involved, locations, and times
of the witnessed actions. (Use the back of this page if needed.)
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I affirm that the information on this page is true and that I personally witnessed the actions described.
Signed: _______________________________________________________Date: __________________________
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Parent category: Legal