CHILD PROTECTION DECLARATION FORM |
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Personal disclosure of all coaches, team managers and authorised helpers, working in contact with young people and children. Have you ever been convicted of a criminal offence or been subject of a Caution or Bound Over order? Yes .. No If Yes, please state the nature and date(s) of the offence(s):
Have you ever been subject to any disciplinary action or sanctions relating to Child Abuse? If Yes, please give details:
You are required to self-certify that you are not known to any Social Services Department as being an actual or potential risk to children, and that you have not been disqualified or prohibited from fostering children, or had any rights or powers in respect of any child vested in or assumed by a local authority, or had a child ordered to be removed from your care. Signed .. Dated .. Name ... Any Surnames previously known by .. Address Date of birth Place of birth ..
You are advised that under the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 as amended by the Rehabilitation of Offenders Act 1974 (Amendment) 1986, you should declare all convictions (including spent convictions). You should advise the Club of any convictions incurred by you after completion of this form. You are advised that the Club reserves the right to make reference to the Local Authority Social Services Department and Police Records to verify the information given by this form. This form will be held securely by Brighton & Hove Cricket Club. |
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