Safeguarding & Disclosure Form

All responses are confidential and will only be shared with relevant people.

Name of Chanich/Chanicha in question(Required)

First Last

Your name(Required)

First Last

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Name of Chanich/Chanicha in Question(Required)

Provide full name

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Name of Tzevet member(Required)

Date(Required)

Machane(Required)

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Name of Machane(Required)

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Year Group or Age of young person(Required)

What was said?(Required)

Please include as much detail as possible, including times of events/conversations.

Who else has been informed?(Required)

What other action was taken?(Required)

The Rosh has been informed(Required)

Yes