CANUSA Declaration Form

CANUSA Declaration Form
I attest that i have advised the CANUSA Games Board of Directors Police Liaison(s) If I become the subject of any crimininal investigation, if I became the subject of any child/welfare investigations, if my driver's license has been suspended or restricted for any reason, or if any charges were brought against me, even if the charges are pending.

This declaration form is ONLY for past CANUSA participants who have submitted a VSS in the years of 2025,2024,2023. If you're a new participant to the CANUSA Games or your VSS is older than 2023 you must and apply and submit a Vulnerable Sector document.
Please check the appropriate box*

There have been no occurrences as described above since my last police record check or offence declaration formAll reportable matters as described above were discussed with CANUSA Games Board of Directors Police Liaison(s) at the time of the occurences(s)
I hereby attest that the information disclosed herin is true, complete and accurate to the best of my knowledge and belief
Legal Name*

First NameLast Name
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Role*
Sport*
Name Of Athlete (If applicable)*

First NameLast Name
Signature*

Clear
Date*

MonthDayYear
Date
CANUSA Games Witness ( Office Use Only )
Should be Empty: