Police Declaration (LaSalle Minor Hockey Association)

Police Declaration

Failure to execute this process will be in violation of the OHF Screening Policy, this will mean that the individual will be considered to be not in good standing and may be subject to further discipline.

Volunteer Information

Name^*

Date of Birth^*

Telephone Number^*

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

Email Address:^*

Example: yo[email protected]. Your submission will be sent to this address.

Local Minor Hockey Association^*

Team Information

Division^*

Level^*

Team Colour^*

Team Colour, if not listed above:

Declaration

I hereby declare that:^*

I have no convictions for offenses under the Criminal Code of Canada as outlined in the LMHA Police Record Check Policy, 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 offences under the Criminal Code of Canada as specified in the OHF Screening Policy for which a pardon under the Criminal Records Act (Canada) has not been issued or granted.

I hereby declare that:^*

I have no convictions for offences in any other country, up to and including the date of this declaration for which a pardon has not been issued or granted.
I have the following convictions for offences in another country for which a pardon has not been issued or granted.

Supplementary Information

Supplementary Information, including outstanding chargers, warrants and order.

Date #1

Location #1

Charge #1

Disposition #1

Date #2

Location #2

Charge #2

Disposition #2

Date #3

Location #3

Charge #3

Disposition #3

Date #4

Location #4

Charge #4

Disposition #4

The information in this Police Declaration is for the LMHA volunteer identified above in the Volunteer Information section of the form.

I confirm that all of the information that I have provided above is for myself and is true.^*

Police Declaration (LaSalle Minor Hockey Association)

OMHA Digital Network

Failure to execute this process will be in violation of the OHF Screening Policy, this will mean that the individual will be considered to be not in good standing and may be subject to further discipline.

Volunteer Information

Team Information

Declaration

Supplementary Information

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