House League - Screening Disclosure Form (St. Thomas Minor Baseball)

House League - Screening Disclosure Form
PLEASE COMPLETE THE SAFE SPORT E-LEARNING MODULE BEFORE COMPLETING THIS FORM. YOUR NCCP NUMBER WILL BE REQUIRED TO COMPLETE THE FORM.

PERSONAL INFORMATION

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

CERTIFICATION

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.