Screening Disclosure & Police Check result (Port Dover Minor Baseball)

Screening Disclosure & Police Check result

Port Dover Minor Baseball 
Screening Disclosure Form and Privacy Statement
Also Submission of Police Check Results

Once Completed it will be automatically Emailed to the Police Check Manager

Identity

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. 

Disclosure

If you have answered YES to any of the above questions then please complete relevant detail below:

Detail to any Questions answered YES

Police Check Result

Please attach a copy of your recent police check result. Must be within the last 6 months

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 Organisation 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. 

Electronic Signature and date

Completion of your name and date of submission of this form is considered to be a legally binding Electronic Signature