ASRCA Volunteer Sign up Form

Name *

First Name Last Name

E-mail *

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Phone Number *

Area Code Phone Number

Are you over 18? *

Yes No

Date of Birth *

Date

Which canoe club are you associated with? *

Preferred Area to Volunteer, select all that apply: *

Boat Control Boat Driver (need to have certification) Starter Timer Lunch help

Have you been convicted of a crime? *

Yes No

Have you ever been disciplined or sanctioned by a sport governing body or by an independent body? *

Yes No

Are criminal charges or any other sanctions, including those from a sport body, private tribunal or government agency, currently pending or threatened against you? *

Yes No

PRIVACY STATEMENT By completing and submitting this Screening Disclosure Form, I consent and authorize the Alberta Sprint Racing Canoe Association to collect, use and disclose my personal information (when permitted by law) for the purposes of screening, implementation of the Screening Policy, administering membership services, and communicating with National Sport Organizations, Provincial Sport Organizations, Divisions, Discipline-Specific Provincial Sport Organizations, Clubs, and other organizations involved in the governance of sport. Alberta Sprint Racing Canoe Association and its Members do not distribute personal information for commercial purposes.
CERTIFICATION I hereby certify that the information contained in this Screening Disclosure Form is accurate, correct, truthful and complete. I further certify that I will immediately inform Alberta Sprint Racing Canoe Association or the Member (as applicable) of any changes in circumstances that would alter my original responses to this Screening Disclosure Form. Failure to do so may result in the withdrawal of volunteer responsibilities or other privileges and/or disciplinary action.

Any special message you need us to know/

Signature *

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Volunteer Sign up Form

Safe Sport Self Disclosure Form Questions