Criminal Offence Declaration

Download PDF

Or complete and submit the form online 

  • Instructions

    To be completed by all PPMS coaches who have previously submitted a Criminal Reference Check. This form must be submitted each year you coach. Information submitted will remain confidential and will only be shared with the individual selected to conduct coach screening. Information will not be disclosed to anyone without your written consent. All forms submitted electronically will be deleted once printed and any printed form that discloses criminal charges or convictions will be returned to you once screening is complete.
  • I hereby declare that
  • Choose the selection that is most appropriate

    I have no convictions or offences 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)
    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.
    I have the following outstanding charges for offences under the Criminal Code of Canada and I am awaiting legal proceedings.
    By checking this box you declare the information provided to be accurate and correct as of this date.