23/24 Criminal Offence Declaration (Newcastle Village Minor Hockey Association)

23/24 Criminal Offence Declaration

Please complete this 23/24 Criminal Offence Declaration form to act as a placeholder while waiting for official police checks. Please ensure that all information is accurate prior to submission.

NVMHAI Criminal Offence Declaration Form

Please complete all sections

Name:^*

Required

HCR #:^*

Required

Role:^*

Coach
Bench Staff
Board Member
Volunteer

Required

Email:^*

Required

Phone:^*

Required

Example: ###-###-####

Please select one:^*

I have no convictions for offences under the Criminal Code of Canada as outlined in the OMHA Police Record Check Policy, up to an including the date of this declaration for which a pardon has not be issued or granted under the Criminal Records Act (Canada).
I have the following convictions for offences under the Criminal Code of Canada as outlined in the OMHA Police Records Checks Policy, for which a pardon under the Criminal Records Act (Canada) has not be issued or granted.

Required

Please provide details of offences (if applicable) here:

*offences include: assault, threatening, possession of a Substance as defined in the Controlled Drugs and Substances Act, Impaired Driving with a suspended license, Theft, Fraud and Related Offences while in a Position of Financial Trust, Assault with a Weapon, Assault Cause Bodily Harm, Aggravated Assault, Sexual Assault, Sexual Interference, Sexual Exploitation, Invitation to Sexual Touching, Child Pornography, Luring a Child, Voyeurism, Possession for the Purposes of Trafficking, Production of a Substance, Robbery, Use of a Firearm in the Commission of an offence, Firearm Related Offences (with the exception of Unsafe Storage).

Please scan or take a picture of your Vulnerable Sector Check (VSC), as soon as you receive it, and send to [email protected]. This declaration will only act as a placeholder in the interim and will expire within 6 weeks of submission. **All Police Checks will be deleted once recorded**

I acknowledge that the information provided in this Criminal Offence Declaration Form is accurate. In the event that any charges are initiated against me I will immediately notify [email protected] that this Criminal Offence Declaration Form is no longer accurate.^*

23/24 Criminal Offence Declaration (Newcastle Village Minor Hockey Association)

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NVMHAI Criminal Offence Declaration Form

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