CRIMINAL OFFENCE DECLARATION (Blyth Brussels Minor Hockey)

Print CRIMINAL OFFENCE DECLARATION

Full Name^*

Date of Birth:^*

CRIMINAL OFFENCE DECLARATION

I DECLARE, since the last Criminal Background Check collected by this Organization or since the last Criminal Offence Declaration given by me by Blyth Brussels Minor Hockey, that:

CRIMINAL OFFENCE DECLARATION^*
I have no convictions 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 criminal offences under the Criminal Code of Canada for which a pardon under the Criminal Records Act (Canada) has not been issued or granted.
List of Offences:

I agree the above statements to be true, correct and complete^*

Human Validation

Check The Box ^*

CRIMINAL OFFENCE DECLARATION (Blyth Brussels Minor Hockey)

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