Ontario Hockey Federation Criminal Offence Declaration printable pdf download

Ontario Hockey Federation Criminal Offence Declaration

Proud Branch Of

ONTARIO HOCKEY FEDERATION

400 Sheldon Drive, Unit 9, Cambridge, Ontario N1T 2H9

533.9070 F:

620.7476

226

519

CRIMINAL OFFENCE DECLARATION

Print Name:

Date of Birth: ________________________________________________

Month/Day/Year

Referee number:

Member Partner: ____________________ Clinic Location_____________

Date: ___________________

Failure to execute this process will be in violation of the OHF Screening Policy, this will mean

that the official will be considered to be not in good standing and may be subject to further

discipline.

Any questions can be directed to the OHF office.

I, ______________________________, hereby declare that:

(Print Name)

I have no convictions for offenses under the Criminal Code of Canada as specified

in the OHF Screening 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 offenses 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:

___________________________________________________________________

Signature:

Date:

Please complete and submit in a sealed envelope with your name printed on the front, and bring

to the clinic that you are attending.

Office Use Only: Received on______________________________

Recorded by______________________________

OHF Members

Ontario Hockey Federation Criminal Offence Declaration