YOUTH & MINIS SECTION

SAFEGUARDING

HKRU SAFEGUARDING DECLARATION

To be completed by all applicants for Relevant Roles

Under the Hong Kong Rugby Union’s (the “HKRU”) Safeguarding Policy, those who intend to be employed or volunteer in a role which involves or is likely to involve regular contact with children or young people (any person under the age of 18) in relation to rugby (a “Relevant Role”) must complete the following declaration (“Declaration”) to prove their suitability to work with children or young people. If you do not complete the Declaration, you may not be engaged in a Relevant Role. If your Declaration is later discovered to have been false in any material respect, you will be immediately removed from any Relevant Role.

VIEW HKRU SAFEGUARDING POLICY

Name(Required)

First Last

Date of Birth (DD/MM/YYYY)(Required)

DD slash MM slash YYYY

Contact Email Address(Required)

Telephone Number(Required)

Club or Rugby body(Required)

Proposed Relevant Role for Club or Rugby Body

Coach

Manager

Referee

First Aid/Physio

Other (please specify)

Other

Coaching Age Group(s)

Under 4

Under 5

Under 6

Under 7

Under 8

Under 9 (Boys)

Under 10 (Boys)

Under 11 (Boys)

Under 12 (Boys)

Under 9 / 10 (Girls)

Under 12 (Girls)

Under 13 (Boys)

Under 14 (Boys)

Under 16 (Boys)

Under 18 (Boys)

Under 13 (Girls)

Under 14 (Girls)

Under 16 (Girls)

Under1 18 (Girls)

Previous experience and qualifications in proposed role (if any)

What (if any) is your connection to the Club or Rugby Body?

Do you have criminal charge/s pending against you before the courts in Hong Kong or elsewhere? (excluding minor traffic offences)(Required)

Yes

Do you have criminal conviction/s or findings of guilt against you for sexual offences, offences related to children, or acts of violence in Hong Kong or elsewhere?(Required)

Yes

Do you have, or have you had, disciplinary proceedings brought against you by an employer, sporting organisation or similar body involving allegations of child abuse, sexual misconduct, sexual harassment, any other form of harassment, or acts of violence?(Required)

Yes

Have you served or are you currently serving a sanction for an antidoping rule violation under a Hong Kong Anti-Doping Committee (“HKADC”) approved anti-doping policy applicable to you?(Required)

Yes

Have you participated in, facilitated, or encouraged practices prohibited by the World Anti-Doping Agency Code or any other HKADC approved anti-doping policy applicable to you?(Required)

Yes

Are you aware of any other matter/s which would make you unsuitable to work closely with children or young people?(Required)

Yes

If you answer “YES” to any of the questions above, you may be required to speak to a Safeguarding Officer (“SO”).

I confirm that I have received and read a copy of the HKRU Safeguarding Policy (the “Policy”). I agree to adhere to the terms of the Policy as amended from time to time, and commit to the HKRU Child Protection Pledge;

I pledge to do the following when I am involved in activities with children and young people;

I will make sure my own behaviour is calm and respectful and I will be clear about the standards of behaviour I expect from children and young people
If there is anger and disagreements between children and young people I will call a time out and try to resolve the issues calmly
I will not try to punish a child by mocking, teasing, or laughing at them or trying to embarrass them in front of others
I will not hit or strike a child as a punishment for bad behaviour. Additionally, I will not shout at children/players in an overly aggressive way, so they feel intimidated, or swear at them.
I will not behave sexually toward a child or touch them in a sexual way
I will do everything I can to make sure the physical environment where the children are playing is as safe and appropriate as possible

I confirm that all of the statements made by me above are true and correct on the date of signing. I will notify the SO of the Rugby Body for whom I am undertaking any Relevant Role immediately upon becoming aware that any matter set out above has changed. In the absence of the SO, I will notify a member of the Club Committee or Board of the Rugby Body.

Check this box to confirm your understanding of the above(Required)

I confirm my understanding and agreement of the above

I confirm that:(Required)

I am aged 18 or above

I am aged under 18

Signature (Please enter your full name)(Required)

This section is to be completed by the parent or guardian of any person under the age of 18 who wishes to perform a Relevant Role.

If you wish to undertake a Relevant Role but are under the age of 18, the additional consent of your Parent/Guardian is required. You must sign where indicated above, and have your parent or guardian sign where indicated below.

I have read and understood the declaration provided by my child. I confirm and warrant that the contents of the declaration provided by my child are true and correct in every particular.

Parent / Guardian's Name(Required)

First Last

Relation to Applicant making this Declaration(Required)

Parent/Guardian's signature (Please enter your full name)(Required)

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YOUTH & MINIS SECTION

HKRU SAFEGUARDING DECLARATION

This section is to be completed by the parent or guardian of any person under the age of 18 who wishes to perform a Relevant Role.

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