Joining Bondi Nippers
JOINING – To be eligible to join Bondi SBLSC Junior Activities (Nippers), children must be five (5) years of age as at the 30th September each year. Proof of age must be supplied at the time of registration. A registration form must be completed and witnessed by a parent/guardian. Under 6′s and Under 7′s do not “surf” as such but do “get wet” in wading and similar events, including those on the beach. These are FUN activities. These age groups are not eligible to compete in junior surf carnivals.
Parental assistance is vital and much appreciated. Courses to assist parents are run by the senior club, Bondi Surf Bathers’ Life Saving Club. They are encouraged to be “age managers”, complete their Life Saving Certificate and Bronze Medallion.
The “nippers” cannot survive without volunteers, be they parents, guardians or friends. Parents/Guardians are invited to consider helping out and there are many ways they can assist. We note the children are very enthusiastic when parents/guardians/adults are involved.
BONDI NIPPERS (U6’s to U14’s)
Season 2011/12
Dear Nipper Families,
Hard to believe but it’s time to start thinking about Nippers again, with registrations starting at the end of August and the first day of Nippers in October.
This year we will keep you up-to-date with regular e-mails, so please make sure you give us your current e-mail address and advise us if your e-mail changes. In a similar way, please keep your mobile phone contact number up to date too.
For those who don’t use e-mail, all notes and hard copies of e-mails will be on display on the Nipper noticeboard, just outside the Nipper room inside the clubhouse.
Please read this letter carefully as it explains all you have to do to register both returning and new Nippers for the forthcoming season.
This year, there will be three registration days – Sunday, 28th August 12.30pm – 2.30pm (for returning Nippers & Siblings only), Saturday, 10th September 12.30pm – 2.30pm (for new and returning Nippers) and Sunday, 18th September 12.30pm – 2.30pm (again, new and returning Nippers).
Due to restrictions on numbers, there is no guarantee registrations on all these dates will be accepted. Numbers in each age group are limited.
Registrations and proficiency swims for all Nippers from U8 to U14’s will be on the same day. The swims will take place at the Swiss Grand (pool at the gym).
Please go to the Swiss Grand first for the proficiency swim, and then come across to Bondi Surf Club with the signed proficiency form and register.
Credit card facilities for payment are available on the day (Visa or MasterCard only). We also accept cash or cheques.
As in previous years, all Nipper costumes and other items of clothing will be on sale at registration. The Uniform Shop will also be open every Sunday morning during the Nippers season.
Bonds are again sponsoring Bondi Nippers, and each registered child will be provided with a rash shirt. These will be distributed once the season commences.
Bondi Nippers will commence at 9 am on Sunday, 9th October 2011 for U8’s to U14’s.
Nippers will start on 16th October for U6 and U7’s (9am).
PARENTS ARE TO BECOME INVOLVED AT BONDI NIPPERS
We are continually working to make Bondi Nippers a club where all children feel proud to be a member, where they learn individual and team skills on the beach and in the surf and, above all, where they have a great time each weekend.
To secure your child’s place at Bondi Nippers, a parent or carer must become involved this season. A Parent Volunteer Policy is enclosed, as well as a parent volunteer form.
The Parent Volunteer form must be handed in with your child’s registration form. Registrations forms at the time of registration will not be accepted without the volunteer form.
We will be very happy to discuss any of these roles with you on any of the registration days.
HOW DO I REGISTER FOR THE 2011/12 SEASON –
Returning Nippers
- Go to the Swiss Grand Hotel (Campbell Pde, Bondi), down to the gym for a proficiency swim. Please bring costume, goggles and swimming cap.
- After the swim, come across to Bondi Surf Club with the completed registration forms included in this mail-out. Please highlight any changes to the information on the forms.
- Children in the U6 and U7’s do not need to do a proficiency swim – come straight to the club to register.
- Registration Days – Sunday, 28th August, Saturday, 10th September or Sunday, 18th September from 12:30 – 2:30.
HOW DO I REGISTER FOR THE 2011/12 SEASON –
New Nippers
- If you wish to register a new Nipper, please print off a registration form from the Bondi Surf Bathers Life Saving Club website (www.bondisurfclub.com).
- Come to either of the Registration Days for new nippers (Saturday, 10th September from 12:30 – 2:30 or Sunday, 18th September from 12:30 – 2:30 pm).
- If your child is born before 30 September 2003, they will need to do a proficiency swim at the Swiss Grand Hotel before coming across to Bondi Surf Club.
- Proof of age (passport, birth certificate, etc.) is required for all new children. This must be shown at the time of registration.
FEES FOR THIS SEASON
For returning Nippers, the fee will be $90 for the first child and $50 for each subsequent child.
For new registrations, the fee will be $90 for the first child and $50 for each subsequent child.
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2011/2012 BONDI NIPPERS PRICE LIST |
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|
ITEM |
MEMBERS PRICE |
NON-MEMBERS PRICE |
| NEW TYR costume line- Nylon Lycra made specifically for Surf Life Saving | ||
| TYR Ladies 1 Piece |
$60.00 |
$70.00 |
| TYR Girls 1 Piece |
$55.00 |
$65.00 |
| TYR Girls 2 Piece |
$60.00 |
$70.00 |
| TYR men’s racer |
$35.00 |
$45.00 |
| TYR boys racer |
$30.00 |
$40.00 |
| TYR Racing singlet |
$40.00 |
$50.00 |
| Quick Response- old stock, limited supply | ||
| Girls 1 Piece |
$40.00 |
$45.00 |
| Girls 2 Piece |
$40.00 |
$45.00 |
| Boys Racers |
$25.00 |
$30.00 |
| Childs T Shirt |
$20.00 |
$25.00 |
| Adult T Shirt |
$25.00 |
$30.00 |
| Rash Shirts |
$25.00 |
not available |
| Baseball cap |
$20.00 |
$25.00 |
| Ladies 1 Piece |
$40.00 |
$50.00 |
| Ladies 2 Piece |
$40.00 |
$50.00 |
| Age caps |
$10.00 |
not available |
Bondi Nippers’ costumes and uniform items will be available for sale on registration days.
We accept cash, cheque or credit card (MasterCard or Visa) – EFTPOS is NOT available.
Bonds are supplying every nipper with a rash shirt, free of charge for the season, although they may not be available until November.
This rash shirt and the coloured Bondi Nippers cap (colour stays with the child throughout every age group) are COMPULSORY for EVERY nippers session.
BONDI NIPPER PARENT VOLUNTEER POLICY
Assistance with the running of Nippers, through training, water safety, officiating, coaching, fundraising, BBQ’s and all of our activities is more than welcome - it is essential!
Without the help of parents, our program simply does not function. Over the last few years, we have seen a sharp decline in the number of parents volunteering their time on Sunday mornings. We have now had to adopt a new policy, in order to secure a volunteer work force, and continued success of our Nipper program. This policy has been adopted by a number of clubs in our area which face the same issues we are encountering at Bondi Nippers.
From the start of the 2011/2012 Bondi Nipper season, no child will be registered in our program unless one parent/guardian commits to one of the many positions required every Sunday morning.
Special circumstances will be assessed on an individual basis by the Director of Juniors.
WORKING WITH NIPPERS
Any volunteer, who undertakes the delivery or supervision of Surf Lifesaving activities for Under 18 members (e.g. age managers, team managers, coaches, trainers, assessors, officials, administrators) act under heightened responsibility.
Such roles are responsible positions within SLSA and Bondi SBLSC, and each person acting within these roles must adopt practices to minimise risk and to thus protect both the people they are working with, and themselves.
It is important that risk minimisation measures be adopted to protect people in these roles from any misconceptions about their behaviour in performing their designated roles.
These practices are outlined in SLSA’s Member Safety and Wellbeing policy which can be found at www.slsa.com.au.
It is for this reason that those wishing to assist in select positions and specific duties must become members of Bondi SBLSC & SLSA.
Anyone who is not a member of SLSA may not have any direct involvement in the running or delivery of any lifesaving activity associated with SLSA members under the age of 18.
Age Manager
Age Managers are responsible for the care, safety, wellbeing and development of the junior surf lifesaver. They are responsible for facilitating the development of surf lifesaving skills. Age Managers play a fundamental role in the development of a learning program that encourages and develops young surf lifesavers.
Age Managers:
- Must be an SLSA and club member;
- Must attend and complete the SLSA Age Managers Award (a 2 hour course, plus on the beach mentoring/coaching);
- Agree to abide by the code of conduct;
- Be responsible for the overall safety and well-being of the group;
- Be responsible for the group’s learning;
- Take time to plan and prepare the activities delivered to the group;
- Foster a collaborative approach to the management of the group;
- Instil enjoyment and fun in what they do; and
- Be a positive role model for Nippers and Surf Lifesaving.
Age Helper
The role of parent Age Helpers is critical to our program. Supportive parents provide essential care, education and enthusiasm. A challenge for parents is getting the right balance between disinterest and overbearing involvement, and being able to read their child’s changing support needs. Age Managers are encouraged to provide a full briefing to parents during the season outlining the Age Managers’ expectations in relation to supporting the children and assisting with activities. The role of the Age helper is to assist the Age Manager in the delivery of the program and supervision of the children.
Age Helpers:
- Must be an SLSA and club member;
- Agree to abide by the code of conduct;
- Work collaboratively with other group managers and helpers;
- Instil enjoyment and fun in what they do; and
- Be a positive role model for Nippers and Surf Lifesaving.
Level 1 Surf Sports Official
Surf Sports Officials are responsible for the safe and fair conduct of surf sports events. It is important that Surf Sports Officials recognise that young surf lifesavers have differing needs, and that the main emphasis of surf sports for youth is fun and developmental. Without the participation of official at carnivals, clubs are not permitted to compete.
Officials:
- Must be an SLSA and club member;
- Must attend a 2 hour course; and
- Attend local training/mentoring at 3 club carnivals and one branch carnival.
Surf & Beach Instructors
Our instructors and coaches are essential to the delivery of instruction, training and development of our Nippers program and curriculum.
Coaches and Instructors:
- Must be an SLSA and club member;
- Be proficient Bronze medallion holders,
- Have a background in surf sport and lifesaving, and
- Ideally have a Surf Sports Level 1 qualification (or related experience).
Water Safety
SLSA regulations dictate that: one water safety member is to be available per five participants; approximately half of the water safety members are to be on rescue craft; and it is desirable that those water safety not on rescue craft wear fins and use rescue tubes or other flotation aids. The Inflatable Rubber Boat is to be in the water where there are 20 or more participants. We encourage anyone interested in water safety to inquire about obtaining their Bronze Medallion.
Water safety:
- Must be an SLSA and club member; and
- Be proficient Bronze medallion or Surf Rescue Certificate holder
BBQ Team
The weekly BBQ is the primary source of our fund-raising for Nippers. Funds are always needed to repair, replace and update the equipment and training gear, and provide education materials for Nippers. Fundraising also pays for all our social events, and the purchase of trophies and medallions.
We need parents to assist with weekly set-up, pack-down and running of the BBQ, generally from 8.00am – 11.30am on Nipper days.
Depending on age group, commitment to the BBQ team is required 3 – 4 times per season as per season calendar.
Beach Work Party
Help is needed every week, from about 8.00 am onwards, to set up the beach and to ensure that everything is packed away on completion of Nippers.
Beach set-up involves:
- Placing age group line up assembly markers
- Taking all boards out of the container and placing them on the beach
- Setting out the running and flag tracks
- Setting up tents, tables, sunscreen and water as required
- Assist with the set-up and pack-down of the beach course and equipment.
- Assist with the removal and return of all equipment.
- Generally an 8:00am start for set-up, and a finish time of 11:30am.
People who volunteer for the BBQ team or Beach Work Party will be placed on a roster. The number of times you will be rostered on during the season will depend on the number of volunteers we receive for these positions.
Competition Coordinator
Ideally a Bronze Medallion holder and Level 1 surf sport official.
- Must be a member of the club;
- To act as Team Manager, for all carnivals;
- Assist the Program Coordinator, Surf Coach, Age Managers & DOJ with team selections as required;
- Liaise with Secretary to enter teams in carnivals.
- Be responsible for competitor and age manager briefings at carnivals; and
- Be responsible for all logistical, delivery, set-up and pack-down at carnivals.
Assistant Registrar
A volunteer is sought to assist the Nippers’ Registrar during the 2011/12 season, with the view of learning the requirements, processes and systems and to assume the Registrar role for subsequent seasons.
Assistant Registrar involves:
- Assisting the Registrar with Nipper registration;
- Helping to maintain the register of all members’ data in Surfguard;
- Helping to keep an accurate record of all attendances, Club Championships results and other internal activities; and
- Be available and volunteer for Registrar from 2012/13
BONDI NIPPER PARENT VOLUNTEER FORM
Please complete this form, even if you already help out at Bondi Nippers.
| Volunteer’s Name: | ||
| Volunteer’s Signature: | ||
| Contact Details | ||
|
e-mail: |
||
|
mobile: |
||
| Child / Children’s name |
Age Group |
|
I wish to volunteer for the following position (please tick as appropriate):
|
Tick (as appropriate) |
Position |
| U6 Age Manager | |
| Age Helper | |
| Level 1 Surf Sports Official | |
| Surf & Beach Instructors | |
| Water Safety | |
| BBQ Team (roster system will operate) | |
| Beach Work Party - Set-Up (roster system will operate) | |
| Beach Work Party – Pack-Up (roster system will operate) | |
| Competition Coordinator | |
| Assistant Registrar |
Membership Form
APPLICATION FOR MEMBERSHIP 20__ / 20__ SEASON
1. CLUB NAME _______________________________________________________________________________ SLSC
2. GENERAL DETAILS
I hereby apply for membership of SLSA. I have read, understood, acknowledge and agree to the declaration and application over leaf. I have signed that declaration
and application.
INITIAL MEMBERSHIP RENEWING
TITLE ____ (Mr, Mrs, Ms, etc) FIRST NAME ____________________ SECOND INITIAL ___ LAST NAME _______________________
MALE FEMALE DATE OF BIRTH ____ / ____ / ____ OCCUPATION ________________________________
ADDRESS __________________________________________________________________________________POSTCODE __________
PHONE: HOME ______________________BUSINESS ___________________________ FAX__________________________________
MOBILE ___ _________________ PREFERRED CONTACT NUMBER NO B / H / M EMAIL_ ___________________________
Drivers License License Number _____ ______________ Vehicle Type ________ _________ Exp Date _ ___________________
Shirt Size (Please Circle) 6 / 8 / 10 / 12 / 14 / XS / S / M / L / XL / 2XL / 3XL / 4XL / 5XL
Short Size (Please Circle) S / M / L / XL / 2XL / 3XL / 4XL / 5XL
3. MEMBERSHIP DETAILS APPLIED FOR – SUBJECT TO CLUB ENDORSEMENT (Tick one box only)
PROBATIONARY……………………………….. ACTIVE (18 years and over)……… ASSOCIATE………………
JUNIOR ACTIVITY MEMBER (5-13 years) ……… AWARD MEMBER…………..… LIFE MEMBER……………
CADET MEMBER (13-15 years)………………… RESERVE ACTIVE………….… GENERAL..………………..
ACTIVE (15-18 years)…………………………… LONG SERVICE………….…… HONORARY………………
Date Joined ________________ Competitive Rights with this club: YES NO Locker Number ______ Key No _ _____
Member Protection Form Completed? YES NO Membership Protection Number (where applicable) _ _ ______________
4. OTHER SURF LIFE SAVING CLUB MEMBERSHIPS (Please attach list if more than two)
_______________________________________________ SLSC_______________________________________________________ SLSC
5. MEDICAL DETAILS
If you suffer or you have suffered from any disease or any physical or mental disability (eg, epilepsy, diabetes or any permanent disability to a limb,
eye or ear) likely to affect your efficiency as a Club member, it may affect your safety and the safety of the public. You should consult your
medical practitioner and SLSA prior to commencing any surf lifesaving activity. You should take part in a Hepatitis B vaccination program.
HAVE YOU READ THIS SECTION? YES NO
6. EMERGENCY CONTACT
FIRST NAME ___________________________________________LAST NAME ______ ________________________________________
RELATIONSHIP _ __________ADDRESS _____________________________________________________ POSTCODE ____________
PHONE: HOME _________________ BUSINESS __________________ FAX: __________________MOBILE: _____________________
7. BACKGROUND DETAILS
Are you from a culturally and linguistically diverse background? YES NO Cultural Background ________________________
Do you use any languages other than English in your home? YES NO Second Language ___________________________
Are you of Aboriginal descent? YES NO Are you of Torres Straight Islander descent? YES NO
8. DECLARATION I have read, understood, acknowledge and agree to the declaration and application and conditions of membership over leaf. I
have signed that declaration and application. I warrant that all information provided is true and correct.
SIGNATURE ________________________________________________________ DATE: _____________________________________
9. PARENT/LEGAL GUARDIAN CONSENT (IN RESPECT TO AN APPLICANT UNDER THE AGE OF 18 YEARS)
I have read, understood, acknowledge and agree to the declaration and application and conditions of membership overleaf and I personally consent to the
declaration and application for Membership of the applicant.
FIRST NAME _ ___________________________________________LAST NAME ____________________________________________
SIGNATURE ___________________________________________________ DATE ___ ________________________________________
10. OFFICE USE ONLY
Date Application received ____ / ____ / ____ Amount paid: $_________________ Receipt No. _ _________________________________
Accepted / Rejected by Club Management – Date ____ / ____ / ____ Signature of Club Officer _ __________________________________
Membership Category allocated _ ___________ Capitation/Membership No. __ __________ ID Sighted – Type _ _________ Date _______
Form 76 -07SLSA MEMBERSHIP APPLICATION &
DECLARATION I [insert name] ………………………………………… of [insert address]………………………………… hereby apply for membership of SLSA. In consideration of my application for membership being accepted I acknowledge and agree that: 1. In this membership declaration: ”Claim” means and includes any action, suit, proceeding, claim, demand, damage, penalty, cost or expense however arising including but not limited to negligence BUT does NOT include a claim against SLSA by any person entitled to make a claim under a relevant SLSA insurance policy or under the SLSA Constitution or SLSA Regulations. “SLSA” means Surf Life Saving Australia Limited. ”SLS Organisations” means and includes SLSA, its subsidiaries, its members (including State Centres & Clubs), Branches and their respective directors, officers, members, servants or agents. ”SLS Activities” means performing or participating in any capacity in any authorised or recognised SLSA activity. 2. If my application for membership is accepted I will be a member of [Insert Club]……………………………… SLSC, [insert Branch if relevant]……………………………., [insert State]……………………………. State Centre & SLSA. I acknowledge my application will be deemed to be accepted upon my participation in SLS Activities and I acknowledge that I will be bound by and agree to comply with the constitutions, regulations and policies of the SLS Organisations. These rules are necessary and reasonable for promoting SLSA and surf lifesaving as a community service. 3. Warning: SLS Activities can be inherently dangerous. I acknowledge that I am exposed to certain risks during SLS Activities including but not limited to physical exertion, contact with surf lifesaving equipment, body contact and surf, sea and weather conditions. I acknowledge that accidents can and often do happen which may result in me being injured or even killed, or my property being damaged. I have voluntarily read and understood this warning and accept and assume the inherent risks in participating in SLS Activities. 4. Exclusion of implied terms: I acknowledge that where I am a consumer of recreational services, as defined by any relevant law, certain terms and rights usually implied into a contract for the supply of goods and services may be excluded. I acknowledge that these implied terms and rights and any liability of the SLSA Organisations (or any of them) flowing from them, are expressly excluded to the extent possible by law, by this membership declaration. To the extent of any liability arising, the liability of the SLS Organisations will, at the discretion of the relevant SLS Organisation, be limited to the resupply of the services or the payment of the cost of having the services supplied again. 5. Release & Indemnity: In consideration of SLSA accepting my application for membership I: (a) release and will release the SLSA Organisations from all Claims that I may have or may have had but for this release arising from or in connection with my membership and/or participation in any SLSA Activity; and (b) indemnify and will keep indemnified the SLSA Organisations to the extent permitted by law in respect of any Claim by any person arising as a result of or in connection with my membership and/or participation in any SLSA Activity. 7. Fitness to Participate: I declare that I am medically and physically fit and able to participate in any SLSA Activity. I am not and must not be a danger to myself or to the health and safety of others. I will immediately notify SLSA in writing through my Club of any change to my medical condition, fitness and ability to participate. 8. Privacy: I understand that the information that I have provided over leaf is necessary for the Objects of the SLS Organisations. I acknowledge and agree that the information will be disclosed to my Club and State Centre and will only be used for the Objects of the SLSA Organisations and to provide me with membership services. I understand that I will be able to access my information through my Club. If the information is not provided my membership application may be rejected. I acknowledge that the SLSA Organisations may also use my personal information for the purposes of providing me with promotional material from SLSA Organisation sponsors or third parties. I may advise my State Centre if I do not wish to receive from the SLSA Organisations, any sponsor or third party material. 9. I have provided the information required overleaf and signed both sides of this form. I warrant that all information provided is true and correct. I acknowledge that this membership declaration cannot be amended. If I do amend it my application will be null and void and cannot be accepted by SLSA. 10. Severance: If any provision of this membership declaration is invalid or unenforceable in any jurisdiction, the phrase or clause is to be read down for the purpose of that jurisdiction, if possible, so as to be valid and enforceable. If the phrase or clause cannot be so read down it will be severed to the extent of the invalidity or unenforceability of it in any other jurisdiction. Such severance does not affect the remaining provisions of this membership declaration or affect the validity or enforceability of it in any other jurisdiction. I have read, understood, acknowledge and agree to the above declaration including the warning, exclusion of liability, release & indemnity. I acknowledge that if my application for membership is successful I will be entitled to all benefits, advantages, privileges and services of SLSA membership. Signed: ................................................................. Date:………………..……..Name: ..................................... …………………. Where the applicant is under 18 years of age this form must also be signed by the applicant’s parent or legal guardian. I,...................................................... am the parent or guardian of the applicant. I authorize and consent to the applicant undertaking the SLS Activities. In consideration of the applicant’s membership being accepted I expressly agree to be responsible for the applicant’s behaviour and agree to personally accept in my capacity as parent or guardian the terms set out in this membership application and declaration including the provision by me of a release and indemnity in the terms set out above. In addition I agree to be bound by and to comply with the SLSA constitution and any regulations and policies made under it. Parent’s signature:................................................ Date: ………………..……Name: ...............………………………………….. (where applicant under 18 y.o)
The Working With Children Employer Guidelines December 2006 AT TA C H M E N T 4 6.4 PROHIBITED EMPLOYMENT DECLARATION The Commission for Children and Young People Act 1998 makes it an offence for a prohibited person (a person convicted of a serious sex offence, the murder of a child or a child-related personal violence offence, as well as a Registrable person under the Child Protection (Offenders Registration) Act 2000) to apply for or otherwise attempt to obtain, undertake or remain in, child-related employment. It does not apply if an order from the Industrial Relations Commission, Administrative Decisions Tribunal or Commission for Children and Young People, declares that the Act does not apply to a person in respect of a specific offence. For further information on what is child-related employment see the Working With Children Employer Guidelines. Section 33B of the Commission for Children and Young People Act 1998 defines a serious sex offence as: • an offence, involving sexual activity or acts of indecency, committed in New South Wales and that was punishable by penal servitude or imprisonment for 12 months or more; or • an offence, involving sexual activity or acts of indecency, committed elsewhere and that would have been an offence punishable by penal servitude or imprisonment for 12 months or more, if it had been committed in New South Wales; or • an offence under section 80D or 80E (sexual servitude) of the Crimes Act 1900, committed against a child; or • an offence under Sections 91D-91G (child prostitution, other than if committed by a child prostitute) of the Crimes Act 1900 or a similar offence under a law other than a law of New South Wales; or • an offence under Section 91H, 578B or 578C (2A) (child pornography) of the Crimes Act 1900 or a similar offence under a law other than a law of New South Wales; or • an offence of attempting, or of conspiracy or incitement, to commit an offence referred to in the preceding paragraphs; or • any other offence, whether under the law of New South Wales or elsewhere, prescribed by the regulations. NOTE: A conviction for carnal knowledge is classified as a serious sex offence under this legislation. Section 33B of the Commission for Children and Young People Act 1998 defines a child-related personal violence offence as an offence committed by an adult: • involving intentionally wounding or causing grievous bodily harm to a child; or • of attempting, or of conspiracy or incitement, to commit such an offence. Under Commission for Children and Young People Act 1998: • it is an offence for a prohibited person to apply for or otherwise attempt to obtain, undertake or remain in child related employment; • employers must ask existing employees, both paid and unpaid, and preferred applicants for child-related employment to declare if they are a prohibited person or not; • all people in child-related employment must inform their employers if they are a prohibited person or remove themselves from child-related employment; and • penalties are imposed for non compliance.The Working With Children Employer Guidelines December 2006 I am aware that I am ineligible to apply for or otherwise attempt to obtain, undertake or remain in, child-related employment if I have been convicted of a serious sex offence or child-related personal violence offence as defined in the Commission for Children and Young People Act 1998, or if I am a Registrable Person under the Child Protection (Offenders Registration) Act 2000. I have read and understood the above information in relation to the Commission for Children and Young People Act 1998. I am aware that it is an offence to make a false statement on this form. I consent to a check of my relevant criminal records, to verify the statements I have made here, being undertaken by the NSW Commission for Children and Young People for monitoring and auditing purposes in accordance with Section 36 (1)(f) of the Commission for Children and Young People Act 1998. I declare that I am not a person prohibited by the Act from seeking, obtaining, undertaking or remaining in child related employment. I understand that this information may be referred to the Commission for Children and Young People and/or to NSW Police for law enforcement purposes and for monitoring and auditing compliance with the procedures and standards for the Working With Children Check in accordance with Section 36 (1)(f) of the Commission for Children and Young People Act 1998. All fields must be completed. Please use block letters. Name: Aliases (previous/other names): Date of birth: Signature: Date: Contact telephone number: Contact Email: NOTE: Seek legal advice if you are unsure of your status as a prohibited person. THIS FORM IS TO BE RETURNED TO YOUR EMPLOYER AT TA C H M E N T 4 ( C O N T I N U E D )
