Date of incident:
Time of incident:
School:	All Saints CES Blessed Chiara Badano CES Blessed Scalabrini CES Blessed Trinity CES Canadian Martyrs CES Cardinal Carter CHS Christ The King CES ConED After School Program ConEd Elearn Summer Continuing Education Summer Program Corpus Christi CES Divine Mercy CES Father Bressani CHS Fr Frederick McGinn CES Fr Henri Nouwen CES Fr John Kelly CES Fr Michael McGivney Academy Good Shepherd CES Guardian Angels CES Holy Cross Catholic Academy Holy Family CES Holy Jubilee CES Holy Name CES Holy Spirit CES Immaculate Conception CES Light Of Christ CES Notre Dame CES Our Lady Help Of Christians CES Our Lady Of Fatima CES Our Lady Of Good Counsel CES Our Lady Of Grace CES Our Lady Of Hope CES Our Lady Of Peace CES Our Lady Of The Annunciation CES Our Lady Of The Lake Catholic Academy Our Lady Of The Lake College CS Our Lady Of The Rosary CES Our Lady Queen of the World Pope Francis CES Prince Of Peace CES Sacred Heart CHS San Lorenzo Ruiz CES San Marco CES Sir Richard W. Scott CES St Agnes Of Assisi CES St Andrew CES St Angela Merici CES St Anne CES St Anthony CES St Augustine CHS St Benedict CES St Bernadette CES St Brendan CES St Brigid CES St Brother André CHS St Catherine Of Siena CES St Cecilia CES St Charles Garnier CES St Clare CES St Clement CES St David CES St Edward CES St Elizabeth CHS St Elizabeth Seton CES St Emily CES St Francis Of Assisi CES St Francis Xavier CES St Gabriel the Archangel CES St Gregory the Great Academy St James CES St Jean De Brebeuf CHS St Jerome CES St Joan Of Arc CHS St John Bosco CES St John Chrysostom CES St John Paul II CES St John XXIII CES St Joseph CES - Aurora St Joseph CES - Markham St Joseph CES - RH St Joseph the Worker CES St Julia Billiart CES St Justin Martyr CES St Kateri Tekakwitha CES St Katharine Drexel CES St Katharine Drexel CHS St Luke Catholic Learning Centre St Margaret Mary CES St Marguerite d'Youville CES St Mark CES St Mary CES St Mary Immaculate CES St Mary of the Angels CES St Matthew CES St Maximilian Kolbe CHS St Michael Academy St Michael the Archangel St Monica CES St Mother Teresa CES St Nicholas CES St Padre Pio CES St Patrick CES - Markham St Patrick CES - Schomberg St Paul CES St Peter CES St Raphael the Archangel CES St Rene Goupil CES St Robert CHS St Stephen CES St Teresa of Calcutta CES St Teresa of Calcutta CHS St Theresa Of Lisieux CHS St Thomas Aquinas CES St Veronica CES St Vincent De Paul CES
Student(s) involved in the incident (Names, nicknames, or description, include grade):   Full Name Nickname Grade Role in the Incident JK SK 1 2 3 4 5 6 7 8 9 10 11 12 N/A
Location of incident:
Description of incident:
How Do You Know? Witnessed Participated Heard from someone else
Who has already been told about this (please select all that apply):   No one Parent/Guardian Teacher Friend School Counselor External Counselor Police
Do you wish to be Contacted: Yes, Please feel free to contact me No, I would prefer that you do not contact me
Please note: Although your name may not be included on the form it is possible from the incident details that the school staff may determine who submitted the form. It is possible that they may approach you directly to offer assistance and/or collect more information. We may need to contact you, even if you would prefer that we did not, so that we can clarify your report in order to respond to it.