Volunteer self-declaration form

Self-declaration form for roles involving contact with children and/or vulnerable adults.

Private and Confidential

Llyn Brenig Sailing Club is committed to safeguarding children and vulnerable adults from physical, sexual and emotional harm. As part of our Safeguarding policy, we require applicants for posts involving contact with these groups to complete this self-declaration form.

If your role will involve regular or frequent contact with, or responsibility for, children you may also be required to provide a valid Enhanced Criminal Records Disclosure, with Barred List check if relevant.

Having a criminal record will not necessarily bar you from working with us. This will depend on the nature of the position and the circumstances and background of your offences.

All information will be treated as confidential and managed in accordance with our data privacy policy and current data protection legislation and guidance.

Your full name

Your email address

Have you ever been known to any Children’s Services Department as being an actual or potential risk to children?

Yes No

If yes, please supply details.

Have you ever been the subject of any disciplinary investigation and/or sanction by any organisation due to concerns about your behaviour towards children or vulnerable adults?

Yes No

If yes, please supply 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 disciplinary action and/or the withdrawal of my appointment.

If required, I agree to provide a valid Criminal Records Disclosure.

I agree to inform Llyn Brenig Sailing Club within 24 hours if I am subsequently investigated by any agency or organisation in relation to concerns about my behaviour towards children or vulnerable adults.

I understand that the information contained in this form and in the Disclosure, or supplied by third parties, may be shared with other persons or organisations in circumstances where this is considered necessary to safeguard children or vulnerable adults.

Signed by

Date