Risk Management Form A

ONCE YOU HAVE READ THE POLICY, CLICK ON THE FORM AT THE BOTTOM


BRITISH COLUMBIA SOCCER ASSOCIATION

RISK MANAGEMENT POLICY - FORM A

This form was updated Sept 4, 2006.

The BCSA thanks you for volunteering your time to assist the Youth of BC in learning and playing the game of soccer. Due to the alarming number of incidents involving adults and youth under their direct supervision, the Board of Directors have devised a procedure under the Risk Management Policy whereby all volunteers are required to complete the VOLUNTEER DISCLOSURE STATEMENT ANNUALLY. The intent of this procedure is to ensure the protection of our volunteers and our youth. Please be assured that maximum confidentiality will be maintained. Your cooperation is greatly appreciated.

Please review the following relevant offenses carefully before proceeding to fill in the online form.

1. VOLUNTEER DISCLOSURE STATEMENT RELEVANT OFFENSES:

Sections of the Criminal Code (Canada)

S151 Sexual interference, S152 Invitation to Sexual Touching, S153 Sexual Exploitation, S154 Sexual exploitation of a person with a disability, S155 Incest, S159 Anal Intercourse; S160 Bestiality; S161 Order of Prohibition; S163.1 making, distribution or possession of Child Pornography; S170 Parent or Guardian Procuring Sexual Activity; S172 Corrupting Children; S173.1 Indecent Acts; S173.2 Exposure; S177 Trespassing at Night; S179 Vagrancy; S212.1 Procuring a Person for the Purpose of Prostitution; S212.2 Living Off Avails of Child Prostitution; S212.4 Attempting to Obtain the Sexual Services of a Child; S215 Duties of a person to Provide Necessities; S218 Abandoning Child; S219 Criminal Negligence S220 Criminal Negligence Causing Death;

S221 Criminal Negligence Causing Bodily Harm; S222 Homicide; S229 Murder; S230 Murder in the commission of an offense; S233 Infanticide; S238 Killing Unborn Child in Act of Birth; S239 Attempt to Commit Murder; S240 Accessory after Fact to Murder; S243 Concealing Body of Child; S244 use of a firearm with intent to Cause Bodily Harm; S245 Administering a Noxious Substance; S264 Criminal harassment; S264.1 Uttering Threats; S266 Assault; S267 Assault with a Weapon or Assault Causing Bodily Harm;

S268 Aggravated Assault; S269 Unlawfully Causing Bodily Harm; S269.1 Torture; S270 Assault peace officer; S271 Sexual Assault; S272 Sexual Assault with a Weapon; S273 Aggravated Sexual Assault; S273.3 Removal of Child from Canada; S279 Kidnapping; S279.1 Hostage Taking; S280 Abduction of Person under Sixteen; S281 Abduction of Person under Fourteen; S282 Abduction in Contravention of Custody Order; S283 Abduction; S 344 Robbery; S346 Extortion; S433 Arson; S372 False Messages/Indecent Telephone Calls/Harassing Telephone Calls; S810 Peace bond where fear of injury, damage or sexual offence.

2. The following sections of the Food and Drug Act (Canada) are designated relevant offences:

S39 Trafficking in Controlled Drug; S40 Trafficking in Restricted Drug.


3. The following is designated as a relevant offence:

S4 Trafficking. Narcotic Control Act (Canada)
S5 Trafficking. Controlled Drugs and Substances Act (Canada)

4. Additional Relevant Offences:


Conviction; Suspension; or Fine for the offence of Driving while under the influence of drugs and/or alcohol.


APPLICATION

I, the undersigned, understand that my volunteer position with the BCSA is contingent upon a review and approval of this truthfully completed and signed VOLUNTEER DISCLOSURE STATEMENT. I realize that the information, which I have provided, is subject to verification, which may include a criminal-history check. I accept that if I am permitted to volunteer, I may be discharged for any misrepresentation or omission on this form or as a result of the verification process

By signing this Application, you are consenting on your behalf to the collection, use, and disclosure of your personal information for the purposes of the BC Soccer Association, the District Soccer Association, and the Soccer Club. The personal information you provide will be used for purposes reasonably associated with you. The main use of the information is to obtain insurance and for use in any necessary disciplinary proceedings. The personal information will not be disclosed to third parties other than as stipulated unless required by law. If you wish to know more about the privacy policies of BC Soccer Association and its members, please contact the Executive Director of the BC Soccer Association at (604) 299-6401.



CLICK HERE TO COMPLETE FORM A