London Talons Volunteer Screening Disclosure Form 2023 (London Talons Baseball)

Print London Talons Volunteer Screening Disclosure Form 2023

All volunteers with the London Talons Baseball Club over the age of 18 are required to abide by the Baseball Ontario Volunteer Screening Policy. To do so, this form must be completed annually.

Volunteer Name

First Name^*
Middle Name(s)^*
Last Name^*
Other Names You Have Used

Player Information

For parent volunteers, this is mandatory as to track for any team or tournament volunteering etc. For non-parent volunteers, please enter N/A in all name fields.

Team

Parent/Guardian Volunteers only.
First Name^*

Enter N/A for non-parent volunteers.
Last Name^*

Enter N/A for non-parent volunteers.

Current Permanent Address

Street Address^*
City^*
Postal Code^*

Other Personal Information

Date of Birth^*

Open the calendar popup.

Gender^*
Email Address^*

Example: yo[email protected]. Your submission will be sent to this address.
Safe Sport Training^*
Yes
Must be completed once only, this year or previously, link is under Parents on website. https://londontalons.ca/Pages/2741/Safe_Sport_Training.
NCCP #^*

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. Have you ever been convicted of a crime for which a pardon has not been granted?^*
NoYes
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
1. Details
2. Are criminal charges or any other sanctions, including those from a sport body, private tribunal or governmentagency, currently pending or threatened against you?^*
NoYes
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
2. Details
3. Has any civil court made a finding, judgment or ruling against you, or have you entered into an out of court settlementrelevant to the profession of coaching, the sport of baseball or any other sport?^*
NoYes
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.
3. Details
4. Have you ever been the subject of a decision of a court or tribunal that might reflect adversely on the professionof coaching, the sport of baseball, or any other sport?^*
NoYes
If yes, please describe below -- type of offence, year of decision, penalty or punishment imposed, and any further explanation if necessary
4. Details
5. Have you ever been dismissed from a position due to allegations of ethical or moral misconduct?^*
NoYes
If yes, please describe below --- name of applicable organization, date of dismissal, reason for dismissal
5. Details
6. Have you ever been disciplined or sanctioned by an international sport tribunal, by a National sport governing body outside Canada, by a National Sport Organization within Canada, or by any other any other sport organization?^*
NoYes
If yes, please describe below -- name of applicable organization, date of discipline or sanction, reason for discipline or sanction,
6. Details

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.

I agree to the terms and conditions stated above^*

Human Validation

Check The Box ^*