Declaration (Clarington Baseball Association)

Print Declaration

Complete this form to submit your Criminal Declaration Form
(only valid if your last CRC on file has VSC and is within 2 years of the season start; May 1st)

Clarington Baseball Association
Home of the Orioles
26 Beech Avenue, Bowmanville, Ontario L1C 3A2
www.claringtonbaseball.ca
Full Legal Name^*
Preferred Name^*
Street Number & Name^*
City^*
Province^*
Postal Code^*
Primary Phone Number^*

Example: ###-###-####
Role^*
CoachAssistant CoachManagerBoard of Directors
Team^*

(i.e. Rep 15U T2, Select 13U, Board of Directors)
CBA requires all adult volunteers to provide a Criminal Reference Check with Vulnerable
Sector Check (CRC/VSC) every 2 years (from the May 1st of the current playing season)
and a Criminal Offence Declaration each year a CRC/VSC is not required. Volunteers who
do not provide a CRC/VSC or Declaration may not act in a volunteer role with the CBA
including but not limited to: Board Member, Coach, Assistant Coach, Trainer, Manager/Co-Manager or Official (e.g. umpire, UIC).

DECLARATION
I hereby declare that:^*
I have no convictions or outstanding charges for offenses under the Criminal Code of Canada 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)
I have the following convictions for offenses under the Criminal Code of Canada for which a pardon under the Criminal Records Act (Canada) has not been issued or granted (provide details below)
If you have convictions, please list all convictions, including date, location, charge(s), disposition
I declare that the above information I have provided is accurate and true

.^*

Human Validation

Check The Box ^*