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Hi there, please fill out and submit this Canada Soccer Club Licence Safety form.
25
Questions
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1
Club
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2
Name of Club representative
First Name
Last Name
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3
What level of Canada Soccer Club Licence is your organization applying for?
Quality Soccer Provider
PTSO Level 1
PTSO Level 2
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4
Code of Conduct to Protect Children
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5
Guidelines for Appropriate/Inappropriate Conduct between Adults/Adolescents and Children
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6
Policy requiring that any suspicion of child abuse is reported to law enforcement
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7
Policy outlining what to do if you witness inappropriate conduct
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8
Rule of Two Policy
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9
Please describe the implementation of the Canada Soccer Guide to Safety within the organization
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10
Commit to Kids Liaison Name
First Name
Last Name
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11
Commit to Kids Liaison Phone Number
Area Code
Phone Number
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12
Commit to Kids Liaison Email
example@example.com
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13
Upload Commit to Kids Certificate
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14
The organization is committed to providing a safe soccer experience
YES
NO
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15
The organization is committed to adherence to the Canada Soccer Code of Conduct and Ethics
YES
NO
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16
Policy outlining what to do if you witness inappropriate conduct is provided to parents, coaches, and team personnel
YES
NO
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17
The organization provides an environment that supports participant’s physical and emotional safety (free of bullying, discrimination, etc.)
YES
NO
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18
The organization has signed the Coaches Association of Canada Responsible Coaching Movement Pledge
YES
NO
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19
The organization educates players, parents, coaches, and team personnel on its Rule of Two Policy
YES
NO
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20
The organization has implemented the Respect in Sport Parent Program
YES
NO
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21
Facilities and equipment are safe, well-maintained, and in good condition
YES
NO
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22
The organization provides contact information for the primary liaison for child protection to players, parents, coaches, and team personnel
YES
NO
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23
The organization is actively implementing the Canada Soccer Guide to Safety
YES
NO
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24
Commitment to Safety Operational Plan
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25
On behalf of the organization, I confirm that the organization is committed to providing a safe environment for all participants
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