The following is the policy of the Jr. Greyhound Association:

The undersigned is committed to provide a safe environment and to prevent child abuse and sexual misconduct.

The undersigned will make every reasonable effort to ensure that every person involved in coaching/training a sport activity will abide by the SafeKids guidelines.

The undersigned will make every reasonable effort to exclude any adult with a legally documented history of child abuse/molestation or any other record that would bring unnecessary risk to the health and safety of participants of this organization. Therefore, every person applying for a position as a coach/trainer must complete a disclosure statement.

The undersigned will take appropriate action on all allegations of child abuse and/or sexual misconduct. All allegations will be reported immediately to the authorities for investigation and will cooperate fully with any such investigation.

SafeKids Guidelines

• Physical, mental and verbal abuses are forbidden
• Inappropriate touching is forbidden
• Coaches/trainers should not socialize with participants outside of the sponsored activities of the organization
• Coaches/trainers should not ride solo with a child
• Parents are encouraged to attend sponsored activities
• If a child needs special attention (one – on – one), do it with the assistance of another adult

Disclosure Statement

 

________________________________________________________________________
    First Name                               Middle Initial                            Last Name

_______________________________
    Social Security Number

________________________________________________________________________
    Street Address                         Town                                       State, Zip Code

________________________________________________________________________
    Driver’s License Number                                  State                            Expiration Date

1. Background in youth sports: Position(s)                                Date(s)

                                                            __________________________________________

                                                            __________________________________________

                                                            __________________________________________

Residence for the past 5 years

                                                            __________________________________________

                                                            __________________________________________

                                                            __________________________________________

 

Have you ever been convicted of a crime?  If yes please explain:

________________________________________________________________________

________________________________________________________________________

 

Coaches’ game ejection for unsportsmanlike conduct:

1^st offense, $50.00 fine and next game suspension

2^nd offense, $100.00 fine and two game suspension

3^rd offense, dismissal from coaching position

All fines must be paid to the Jr. Greyhounds before a coach can participate in practices or games.

 

By signing this document, I have read and understand this document and herby verify that the information I provided is true and correct.

 

________________________________________________________________________                                              Print Name                                       Date                                       Signature