Member Protection Declaration

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Date
I am a*
- Coach
- Team Manager
- other Official
I solemnly and sincerely declare as a volunteer for the MONTROSE VIKINGS BASKETBALL CLUB conducted by JUNIOR DOMESTIC.
1. I have never been charged with any criminal offence relating to narcotics, violence or abuse including sexual abuse.
2. No person has ever sought or obtained any intervention order, injunction or other restraining order against me alleging dishonesty or verbal or physical abuse (including sexual abuse).
3. I am not currently the subject of any sanction issued by a basketball association against me which prohibits me from holding a position of the type set out in clause 1 above.
4. No application submitted on my behalf has been rejected for, nor have I been suspended or dismissed from, a position in sport, volunteer organisation, business, educational or other Government or semi- government organisation where that rejection, suspension or dismissal relates to my conduct with persons aged under eighteen (18) years of age or to violence, drug use or to dishonesty.
5. There are no other matters, which a reasonable person would consider relevant to the fitness of a person to be a coach of a team of players aged under eighteen or an administrator with frequent contact with persons aged under eighteen.
6. I will notify the President or CEO of the organisations appointing me to my position immediately upon becoming aware that any of the matters set out in clauses 2 to 6 above has changed for whatever reason.
I make this declaration that the information contained in it is true and correct and I make it understanding that a person making a false declaration is liable to the penalties of perjury.
Name*
First Last
Signature*

Member Protection Declaration

2025 Annual General Meeting

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