Offence Declaration

Get Low Dance Co.

1. Instructions

• Licensees must obtain offence declarations from all individuals from whom they have previously obtained a vulnerable sector check. The offence declaration must be obtained in every calendar year, except a year in which a vulnerable sector check is obtained, and dated no later than 15 days after the anniversary date of the most recent offence declaration or vulnerable sector check.

• Licensees must obtain a statement from any person who turns 18 years old while in a position where he or she interacts with children receiving care, within one month after the person turns 18 years old. The statement must disclose every previous finding of guilt of the person under the Youth Criminal Justice Act (Canada), if the person received an adult sentence.

• Where a licensee has accepted a copy of a vulnerable sector check from a volunteer or student, instead of the original documents, the volunteer or student must provide an offence declaration that addresses the period since day the vulnerable sector check was performed if more than six months but less than five years have passed since the day the vulnerable check was performed.

• Any person from whom a licensee is required to obtain a vulnerable sector check is required to provide the licensee with an offence declaration, as soon as reasonably possible, any time he or she is convicted of an offense under the Criminal Code (Canada).

  
  

  This form must be completed and signed by the individual from whom an offence declaration is required. The form must also be signed by the licensee or designate to confirm receipt. This form must be retained for ministry review.

2. Declaration

I

declare that since

I declare that the above discloses all of my convictions under the Criminal Code (Canada) since the date specified above.

In addition, I am aware of my duty to provide Get Low Dance Co., as the case may be, with an offence declaration as soon as reasonably possible at any time I am convicted of an offence under the Criminal Code (Canada)