Volunteer Criminal Offence Declaration Form (Dorchester Minor Hockey Association)
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Volunteer Criminal Offence Declaration Form
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Volunteer Criminal Offence Declaration Form
**Submission of false information on an Offence Declaration will result in immediate termination of a volunteer service and suspension of membership***
Full Legal Name(s):
*
Required
Date of Birth:
Current Address:
Phone Number:
Example: ###-###-####
Email Address:
Example:
[email protected]
Team(s)/Position(s)
*
Required
I declare that,
*
I have no convictions for offences under the Criminal Code of Canada or the law of any other country up to and including the date of this declaration for which a pardon has not been issued or granted under the Criminal Records Act (Canada) or its equivalent.
I have the following convictions for offences under the Criminal Code of Canada or law of another country for which a pardon under the Criminal Records Act (Canada) or its equivalent has not been issued or granted.
Required
Offence Date/Court Location/Conviction:
Offence Date/Court Location/Conviction:
Date Digitally Signed
*
Required
Digital Signature
I acknowledge that all of the information contained in this declaration is true and that my electronic signature affixed has the same force and legal effect as if signed personally by me.
*
(type full name)
*
Required
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