Self-disclosure form

Self-disclosure form for HHSC members relating to contact with children and/or adults at risk

Hill Head Sailing Club is committed to safeguarding children and adults at risk, from physical, sexual and emotional harm. As part of our Safeguarding policy, we require all adult members to complete this self-disclosure form annually as part of our membership renewal process. Having a criminal record will not necessarily bar you from joining the club. This will depend on the nature of volunteering duties and the circumstances and background of your offences.

All information will be treated as confidential and managed in accordance with data protection legislation and guidance. You have a right of access to information held about you under the Data Protection Act

    Your Name

    Your Email

    Do you have any convictions, cautions, reprimands or final warnings that are not ‘protected’ as defined by the Rehabilitation of Offenders Act 1974 (Exceptions) Order 1975 (as amended in 2013)?

    YesNo
    If yes, please supply details.

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

    YesNo
    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?

    YesNo
    If yes, please supply details.

    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 membership / volunteering role.

    I understand that I may be asked to provide a Criminal Records Disclosure and consent to do so if required.

    I agree to inform the organisation within 24 hours if I am subsequently investigated by any agency or organisation in relation to concerns about my behaviour towards children or young people.

    I understand that the information contained in this form and in the Disclosure, or relating to subsequent concerns about my behaviour, may be shared with regulatory bodies and/or other persons or organisations, in circumstances where this is considered necessary to safeguard children and vulnerable adults.

    Please enter your name to sign here:

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