London Talons Volunteer Screening Disclosure Form (London Talons Baseball)

Print London Talons Volunteer Screening Disclosure Form
This form is to be completed by all London Talons volunteers annually. For insurance purposes, all family guardians are considered volunteers with their teams for the season, and with the association as required for tournament and other volunteering as required.
Name
  1. Comma separate multiple players names, or put N/A if non-parent volunteer.
Current Permanent Address
Other Personal Information
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  2. Example: [email protected] Your submission will be sent to this address.
  3. Must be completed once only, this year or previously.
  4. Provided when completed Safe Sport Training at Coach.ca or through Coach Training at nccp.baseball.ca
Disclosure Information
Note: Failure to disclose a conviction/sanction for which a pardon has not been granted may be considered an intentional omission and subject to failure of screening requirements as required by the Organization’s Screening Policy.
  1. If yes, please describe below for each conviction. Name or Type of Offense, Name and Jurisdiction of Court/Tribunal, Year Convicted, Penalty or Punishment Impose, and any Further Explanation
  2. If yes, please explain for each pending charge -- Name or type of Offence, Name and Jurisdiction of Court/Tribunal and any further explanation if necessary
  3. If yes, please describe each finding, judgment or ruling below. Civil Court Finding, Out of Court Settlement, Type of Finding, Year of Offence or Settlement, Penalty or Punishment Imposed. And any further explanation if necessary.
  4. If yes, please describe below -- type of offence, year of decision, penalty or punishment imposed, and any further explanation if necessary
  5. If yes, please describe below --- name of applicable organization, date of dismissal, reason for dismissal
  6. If yes, please describe below -- name of applicable organization, date of discipline or sanction, reason for discipline or sanction,
  1. Certification
    I hereby certify that the information contained in this application is accurate, correct, truthful and complete. I further certify that I will immediately inform the Organization of any changes in circumstances that would alter my original responses to this Screening Disclosure Form. Failure to do so may result in termination of membership and/or further discipline.

    PRIVACY STATEMENT
    By completing and submitting this Screening Disclosure Form, you consent and authorize the Organization to collect, use and disclose your personal information, including all information provided on the Screening Disclosure Form, Police Record Check and/or Vulnerable Sector Check for the purposes of screening, implementation of the Organization’s Screening Policy, administering membership services and communicating with other National Sport Organizations, Provincial Sport Organizations, Sport Organizations, and other organizations involved in the governance of the sport of baseball. The Organization does not distribute personal information for commercial purposes.
Human Validation