Sincerely declare:
1. I do not have any criminal charges pending before the courts.
2. I do not have any criminal convictions or findings of guilt for sexual offences, offences relating to children or acts of violence.
3. I have not had any disciplinary proceedings brought against me by an employer, sporting organisation or similar body involving child abuse, sexual misconduct or harassment, other forms of harassment or acts of violence.
4. I am not currently serving a sanction for an anti-doping rule violation under an ASADA approved anti-doping policy applicable to me.
5. I will not participate in, facilitate or encourage any practice prohibited by the Word Anti-doping Agency Code or any other ASADA approved anti-doping policy applicable to me.
6. To my knowledge there is no matter that APSA Inc. may consider to constitute a risk to its members , volunteers, athletes or reputation by engaging me.
7. I will notify the President of APSA Inc and its member association engaging me immediately upon becoming aware that any of the matters set in clause 1 to 6 above has changed.
This form will be held securely on file for a period of 2 years.