SSKC Welfare

Saturday 27 December 2008

Instructor / Helper form

Instructor / Helper declaration form

United Kingdom legislation and guidance relating to the welfare of children has at its core, the principle that the welfare of children and young people must be the paramount consideration. Selby Shotokan Karate Club fully support this principle and therefore, we require that everyone connected with Selby Shotokan Karate Club, who will come into contact with children or personal details of children, complete and sign this declaration. This record is to ensure that children’s welfare is safeguarded and shall be kept for the duration of the initiative and for a period of 12 months thereafter.

Has any children’s services department, the NSPCC or the police ever conducted an enquiry or investigation about any allegations or concerns that you may pose an actual or potential risk to children or young people?
Yes / No

Have you ever been convicted of any offence relating to children or young people?
Yes / No

Have you ever been the subject of disciplinary procedures or been asked to leave employment or voluntary activity due to inappropriate behaviour towards a child?
Yes / No

This declaration must be signed and returned to the Club Secretary prior to commencing any work relating to this initiative, which would involve contact with children or personal details of children.

I confirm that the above information given by me is correct and that I consent to my personal data being processed and kept for the purpose described above in accordance with the Data Protection Act 1998

Name

Designation

Signature

Date

You are advised that under the provisions of the Rehabilitation of Offenders Act (NI Order) (1974) (Exceptions) Order 1975 as amended by the Rehabilitation of Offenders Act 1974 (Exceptions) (Amendments) Order 1986 you should declare all convictions, including spent convictions.

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