Screening Disclosure Form and Privacy Statement (Turtle Club Baseball and Softball)

Print Screening Disclosure Form and Privacy Statement

The Screening Policy of Baseball Ontario requires our club, Turtle Club Baseball and Softball ("TC", including LaSalle Titans Baseball and LaSalle Athletics), to, among other things, obtain this Screening Disclosure Form, every 3 years, from all of the club's volunteers, including coaches, managers, parent helpers, umpires, directors, groundskeepers and concession staff. In this form, "Organization" refers to either Baseball Ontario or TC, as applicable. TC has adopted Baseball Ontario's Screening Policy for all of its programs.

Identification

Full Legal Name^*
Other Name(s) Used
Current Permanent Address^*

Date of Birth^*

Open the calendar popup.

E-mail Address^*

Example: [email protected]

Screening Questions

1. Have you ever been convicted of a crime for which a pardon has not been granted?^*
YesNo
If yes, please describe below.
Name(s) or Type(s) of Offense(s)
Name(s) and Jurisdiction of Court(s)/Tribunals
Year(s) Convicted
Penalty(ies) or Punishment(s) Imposed
Further Explanation
2. Are criminal charges or any other sanctions, including those from a sport body, private tribunal or government agency, currently pending or threatened against you?^*
YesNo
If yes, please explain below.
Name(s) or Type(s) of Offense(s)
Name(s) and Jurisdiction of Court(s)/Tribunals
Further Explanation
3. Has any civil court made a finding, judgment or ruling against you, or have you entered into an out of court settlement relevant to the profession of coaching, the sport of baseball/softball or any other sport?^*
YesNo
If yes, please describe each finding, judgment or ruling below.
Civil Court Finding(s)
Out of Court Settlement(s)
Year(s) of Offense(s) and/or Settlement(s)
Penalty(ies) or Punishment(s) Imposed
Further Explanation
4. Have you ever been the subject of a decision of a court or tribunal that might reflect adversely on the profession of coaching, the sport of baseball/softball, or any other sport?^*
YesNo
Type(s) of Offense(s)
Year(s) of Decision(s)
Penalty(ies) or Punishment(s) Imposed
Further Explanation
5. Have you ever been dismissed from a position due to allegations of ethical or moral misconduct?^*
YesNo
Name(s) of Applicable Organization(s)
Date(s) of Dismissal(s)
Reason(s) for Dismissal(s)
6. Have you ever been disciplined or sanctioned by an internal sport tribunal, by a national sport governing body outside Canada, by a national sport organization within Canada, or by any other sport organization?^*
YesNo
Name(s) of Applicable Organization(s)
Date(s) of Discipline or Sanction(s)
Reason(s) for Discipline or Sanction(s)

I hereby certify that the information contained in this application is accurate, correct, truthful and complete. I further certify that I will immediately inform the Organization of any changes in circumstances that would alter my original responses to this Screening Disclosure Form. Failure to do so may result in termination of membership and/or further discipline.

I acknowledge that the checking of this box and the electronic submission of this form constitutes my electronic signature to this Screening and Disclosure Form.^*

Human Validation