Member Protection Declaration
I wish to be appointed as a coach in the Basketball Queensland State and Emerging State Team Program and do solemnly declare that:
1. I have never been charged with any criminal offense relating to narcotics, violence or abuse including sexual abuse.
2. No person has ever sought or obtained any intervention order, injunction or other restraining order against me alleging dishonesty or verbal or physical abuse (including sexual abuse).
3. I am not currently the subject of any sanction issued by a basketball association against me which prohibits me from holding a position of the type set out in clause 1 above.
4. No application submitted on my behalf has been rejected for, nor have I been suspended or dismissed from, a position in sport, volunteer organisation, business, educational or other Government or semi-government organisation where that rejection, suspension or dismissal relates to my conduct with persons aged under eighteen (18) years of age or to violence, drug use or to dishonesty.
5. There are no other matters, which a reasonable person would consider relevant to the fitness of a person to be a coach of a team of players aged under eighteen or an administrator with frequent contact with persons aged under eighteen.
6. I also agree to uphold the acceptable standards of behaviour and conduct whilst acting in my role and are fully aware and accept that should any of these standards listed in the code of conduct be breached I will be dismissed from my role within this program and acknowledge that I will also be excluded from all future Basketball Queensland Development Programs at all levels.
7. I will notify the CEO of the organisations appointing me to my position immediately upon becoming aware that any of the matters set out in clauses 2 to 6 above has changed for whatever reason.
8. I make this declaration that the information contained in it is true and correct and I understand that a person making a false declaration is liable to the penalties of perjury.