2023 Coach Registration and Volunteer Screening (Ancaster Minor Baseball Association)

Print 2023 Coach Registration and Volunteer Screening

New Coaches and volunteers in 2023 must also submit a Vulnerable Sector check

Full Name

First Name^*
Middle Name
Last Name^*
Other Names You have Used

Current Permanent Address

Street^*

ie. 23 Elm Street
City^*
Province^*
Postal Code^*

ie. L9G3F5

Personal Information

Gender^*

Date of Birth^*

Open the calendar popup.

Email Address^*

Example: [email protected]
Phone #^*

Cell # preferred
NCCP #^*

Required for OBA Rostered Coaches, Other may enter 0000
What Team are you Volunteering for in 2023^*

Screening Disclosure and Privacy Statement

All Coaches and Volunteers Must complete this Section for 2023. Answering Yes to any of these questions will Require a review from the AMBSA Screening Committee

Have you ever been convicted of a crime for which you have not recieved a pardon?^*
NOYES
Are Criminal Charges or Any other sanctions including those from a sports body, private tribunal, or government agency pending against you^*
NOYES
Has any civil court made a finding, ruling or judgement against you or have you ever entered in to an out of court settlement relevant to the profession of coaching, the sport of baseball or any other sport?^*
NOYES
Have you ever been subject of a decision of a court or tribunal that might reflect adversly on the profession of coaching, the sport of baseball or any other sport?^*
NOYES
Have you ever been dismissed from a position due to allegations of ethical or moral misconduct?^*
NOYES
Have you ever been disciplined or sanctioned by an international sport tribunal, National Sport governing body outside or within Canada, or by any other sport Organization?^*
NOYES

Certification

By checking the box below, 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.

PRIVACY STATEMENT: By completing and submitting this Screening Disclosure Form, you consent and authorize the Organization to collect, use and disclose your personal information, including all information provided on the Screening Disclosure Form, Police Record Check and/or Vulnerable Sector Check for the purposes of screening, implementation of the Organization’s Screening Policy, administering membership services and communicating with other National Sport Organizations, Provincial Sport Organizations, Sport Organizations, and other organizations involved in the governance of the sport of baseball. The Organization does not distribute personal information for commercial purposes.

I agree to the terms and conditions stated above^*
Volunteer Screening Attestation or Police Check

By checking the box below, I certify that there have been no changes to my criminal record since I last submitted an Enhanced Police Information Check and/or Vulnerable Sector Check and/or Screening Disclosure Form to Baseball Ontario. I further certify that there are no outstanding charges and warrants, judicial orders, peace bonds, probation or prohibition orders, or applicable non-conviction information, and there have been no absolute and conditional discharges.

I agree that any Enhanced Police Information Check and/or Vulnerable Sector Check and/or Screening Disclosure Form that I would obtain or submit on the date indicated below would be no different than the last Enhanced Police Information Check and/or Vulnerable Sector Check and/or Screening Disclosure Form that I submitted to Baseball Ontario. I understand that if there have been any changes, or if I suspect that there have been any changes, it is my responsibility to obtain and submit a new Enhanced Police Information Check and/or Vulnerable Sector Check and/or Screening Disclosure Form to Baseball Ontario’s Screening Committee instead of this form.

I recognize that if there have been changes to the results available from the Enhanced Police Information Check and/or Vulnerable Sector Check and/or Screening Disclosure Form, and that if I submit this form improperly, then I am subject to disciplinary action and/or the removal of volunteer responsibilities or other privileges at the discretion of the Screening Committee.

I agree to the terms and conditions stated above^*

Human Validation

Check The Box ^*