JUNIOR YOUTH & SENIOR YOUTH

SAFEGUARDING

HKCR SAFEGUARDING DECLARATION

To be completed by all applicants for Relevant Roles

Under the Hong Kong China Rugby’s (the “HKCR”) 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.

You are required to complete the Declaration annually, even if you have already done so in previous seasons, before you may be engaged in a Relevant Role for the current season.

If you wish to discuss any safeguarding matters in confidence with our Safeguarding Officers, please email us.

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VIEW HKCR 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)

Proposed Relevant Role (Please select all that apply)(Required)

Coach

Manager

Referee

Safeguarding Officer

First Aid/Physio

Other (please specify)

Other

Coaching Age Group(s) (Please select all that apply)

Under 4

Under 5

Under 6

Under 7

Under 8

Under 9 & 10 Girls

Under 9 Boys

Under 10 Boys

Under 11 & 12 Girls

Under 11 Boys

Under 12 Boys

Under 13 & 14 Girls

Under 13 Boys

Under 14 Boys

Under 16 Girls

Under 16 Boys

Under 18 Girls

Under 18 Boys

Previous experience and qualifications in proposed role (if any)

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

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 anti-doping rule violation under Anti-Doping Organization of Hong Kong, China Limited (“ADOHK”) 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 ADOHK 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 in confidence with a Safeguarding Officer (“SO”) to discuss your suitability for the proposed role.

Player Protection Pledge(Required)

By checking the following boxes, I pledge to do the following when I am involved in activities with players, especially children and vulnerable 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 vulnerable people.