Volunteer Declaration Form (Tillsonburg Minor Hockey Inc.)

Print Volunteer Declaration Form

Please use this form to complete your Volunteer Declaration for the 2 years post Police Check. An up to date Police Check form will be required once every 3 years.

Declaration

I DECLARE, since the last Criminal Background Check collected by this Board, or since the last Offence Declaration given by me to this Board, that:

Full Name

I have no convictions 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).

yes- convictions No- no convictions
I have the following convictions for offences under the Criminal Code of Canada for which a pardon under the Criminal Records Act (Canada) has not been issued or granted.

Please List Date, Court Location and Conviction
This form is held on file with TMHI until a new Police Check form is submitted. That is required once every 3 years.

I agree to the terms and conditions stated above^*
Name of Team