Child Protection self- disclosure

Tynemouth Sailing Club policy is to ensure that children, young people and vulnerable adults enjoy the amenities and activities of the club free from any form of harm; and to encourage custom and practice which protects Instructors and Volunteers from potential or actual accusations of abuse. As part of our procedures we ask non-members and members of less than 2 years standing who are not parents of children under instruction to complete this form.

Name ____________________________________

Have you ever been convicted of any criminal offences? YES NO

If yes please give details; you should declare all convictions including “spent” convictions, cautions, warnings and reprimands.

Are you a person known to any Children and Families Social Care Department as being an actual or potential risk to children? YES NO

If yes please give details.

Have you ever had any disciplinary sanction relating to child abuse?

If yes please give details.

Declaration I declare that to the best of my knowledge the information given above is correct and understand that any misleading statements or deliberate omission may be sufficient grounds for disallowing my participation in activities at Tynemouth Sailing Club. I understand I may be asked to apply for a Criminal Records Disclosure and consent to do so if required. I understand that the information contained in this form and in the Disclosure may be disclosed, where strictly necessary, to regulatory bodies and/or third parties who have an interest in child protection issues.

Signed ________________________ Date