By signing this document below, I certify that there have been no changes to my criminal record since I last submitted an Ehanced Police Information Check and/or Vulnerable Sector Check and/or Volunteer Screening Disclosure Form to the Organization. I further certify that there are no outstanding charges and warrents, judicial orders, peace bonds, probation or prohibitation orders, or applicable non-conviction information, and there have been no absolute and conditional discharges. 

I agree that any Ehanced Police Information Check and/or Vulnerable Sector Check and/or Screening Disclosure Form that I would obtain or submit on the date indicated below would be no diffrent than the last Enhanced Police Information Check and/or Vulnerable Sector Check and/or Application and Screening Disclosure Form that I submitted to the Organization. I undertand that if there have been any changes, or if I suspect that there have been any changes, it is my reponsibility to obtain and submit a new Enhanced Police Information Check and/or Vulnerable Sector Check and/or Volunteer and Screening Disclosure Form to the Organization's Screening Committee or Safe Sport Officer (SSO) instead of this form. 

I recognize that if there have been changes to the results avilable from the Enhanced Police Information Check and/or Vulnerable Sector Check and/or Volunteer Screening Disclosure Form, and that if I submit this form improperly, then I am subject to disciplinary action and/or the removal of volunteer or employment responsibilities or other privileges at the discretion of the Screening Committee or the SSO.