Baseball Ontario Screening Disclosure Form (Ingersoll Minor Baseball )

Baseball Ontario Screening Disclosure Form
Baseball Ontario’s Screening Policy requires Ingersoll Minor Baseball (IMBA) to ensure that all volunteers complete screening requirements. A full Vulnerable Sector Screen must be obtained every three (3) years and submitted to [email protected]. In years when a full Vulnerable Sector Screen is not required, this Screening Disclosure Form must be completed annually. For the purposes of this form, “Organization” refers to either Baseball Ontario or Ingersoll Minor Baseball, as applicable. IMBA has adopted Baseball Ontario’s Screening Policy for all of its programs.

Name

Current Permanent Address

Background

Question 1

Question 2

Question 3

Question 4

Question 5

Question 6

Addition(s)

For more than one conviction please attach additional page(s) as necessary.

Ceertification

I herby 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.