2024 VSC Declaration/Renewal Form (Lucan-Ilderton Baseball)
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2024 VSC Declaration/Renewal Form
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2024 VSC Declaration/Renewal Form
AS A COACH, VOLUNTEER OR BOARD MEMBER WITHIN LIMBA, PLEASE COMPLETE THIS FORM AND CONFIRM THAT YOU UNDERSTAND THE LIABILITY, CONDUCT AND ACKNOWLEDGEMENTS PROVIDED BELOW. ALSO COMPLETE WHEN CONFIRMING VULNERABLE SECTOR CHECK RENEWAL.
Personal Information
Last Name
*
Required
First Name
*
Required
Middle Name
*
Required
Current Permanent Street Address
*
Required
Suite Number
City
*
Required
Postal Code
*
Required
Birth Day
*
Required
Birth Month
*
Select One...
January
February
March
April
May
June
July
August
September
October
November
December
Required
Birth Year
*
Required
Gender
*
Female
Male
Other
Required
Email Address
*
Required
Example:
[email protected]
. Your submission will be sent to this address.
Phone Number
*
Required
Example: ###-###-####
Select Age Group or Role
*
5U Blastball
7U Junior Rookie
9U Baseball
11U Baseball
13U Baseball
15U Baseball
18U Baseball
U11 Girls Softball
U13 Girls Softball
U15 Girls Softball
U17 Girls Softball
U19 Girls Softball
Board member
Volunteer
Required
By submitting this document, I certify that there have been no changes to my criminal record since I last submitted a Vulnerable Sector Check and/or an Enhanced Police Information Check and/or a Screening Disclosure Form to Lucan-Ilderton Minor Baseball
Association
. I further certify that there are no outstanding charges and warrants, judicial orders, peace bonds, probation or prohibition orders, or applicable non-conviction information, and there have been no absolute and conditional discharges.
I agree that any Enhanced Police Information Check and/or Vulnerable Sector Check and/or Screening Disclosure Form that I would obtain or submit on the date I submit this would be no different than the last Vulnerable Sector Check and/or Enhanced Police Information Check and/or Screening Disclosure Form that I submitted to Lucan-Ilderton Minor Baseball Association. I understand that if there have been any changes, or if I suspect that there have been any changes, it is my responsibility to obtain and submit a new Vulnerable Sector Check and/or Enhanced Police Information Check and/or Screening Disclosure Form to
Lucan-Ilderton Minor Baseball Association
instead of this form.
I recognize that if there have been changes to the results available from the Vulnerable Sector Check and/or Enhanced Police Information Check and/or Screening Disclosure Form, and that if I submit this form improperly, then I am subject to disciplinary action and/or the removal of volunteer responsibilities or other privileges at the discretion of Lucan-Ilderton Minor Baseball
Association
.
I agree to the terms and conditions stated above
*
Liability Waiver:
On behalf of myself, I recognize that baseball entails serious risks. Consequently, except as noted below, I relinquish all rights to a claim of any kind, including the right to a claim for bodily and material damages, regardless of the cause, against Baseball Ontario, its member associations, including Lucan-Ilderton Minor Baseball Association and their respective officers, employees, coaches, umpires, assignees, agents, representatives, and sponsors, even if such damages result from negligence of Baseball Ontario, its member associations, including Lucan-Ilderton Minor Baseball Association and their respective officers, employees, coaches, umpires, assignees, agents, representatives, and sponsors.
Without restricting the generality of the preceding, I also relinquish the right to any claim against Baseball Ontario, its member associations, including Lucan-Ilderton Minor Baseball Association and their respective officers, employees, coaches, umpires, assignees, agents, representatives, and sponsors resulting from a decision on their part, regardless of the nature of this decision.
This release of Baseball Ontario, Lucan-Ilderton Minor Baseball Association the other persons noted above does not preclude myself from making a claim under any sports accident coverage provided by Baseball Ontario and/or Lucan-Ilderton Minor Baseball Association to their players, coaches, volunteers, umpires and Directors. An overview of the current sports accident coverage provided by Ontario Baseball Association can be found at
https://www.playoba.ca/insurance
I agree to the terms and conditions stated above
*
Rowan’s Law:
Under Bill 193, Rowan's Law (Concussion Safety), a sport organization shall not permit an individual to serve as a coach for the sport organization or to serve in any other prescribed position, such as an official, in respect of the sport organization unless the individual gives the sport organization confirmation that they have reviewed the concussion awareness resources at the prescribed times and in accordance with the prescribed requirements.
LIMBA requires all coaches, volunteers, umpires and Directors to review the Concussion Education Resources provided by the Province of Ontario and the relevant Baseball Ontario code(s) of conduct associated with your role(s). Links to these resources are provided here and will open in a separate window:
Province of Ontario Concussion Education Resources:
https://www.ontario.ca/page/rowans-law-concussion-safety
Player Code of Conduct
Coach & Volunteer Code of Conduct
Parent Code of Conduct
Umpire Code of Conduct
Concussion Management Protocol
Rowan's Law and Code of Conduct Acknowledgement:
I hereby confirm that coach/volunteer/umpire/director completing this form and the parent or legal guardian if said person is under 18 years of age, have reviewed one of the concussion education resources provided by the Province of Ontario as referenced above and have reviewed the relevant code(s) of conduct and concussion management protocol as referenced above.
I confirm that I/we have reviewed the information appropriate for my role with LIMBA
*
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