CAROLINE SPRINGS BLUE DEVILS BASKETBALL CLUB (CSBDBC)
COACH AND ADMINISTRATOR CHECKS
The committee take very seriously that its players need to be protected from physical violence, mental
violence, exploitation and abuse.
All coaches/assistant coaches and administrators (such as team managers) that are over sixteen
years old and have regular contact with players are to:
1) successfully complete a working with children check (mandatory)
2) complete the “Declaration of coaches and administrators” statutory declaration (mandatory)
3) undergo a police check (at the written request of the CSBDBC Committee)
Part 1 – Working With Children Check
The WWC check is free for volunteers however a passport type photo is required. The CSBDBC will
pay for this photo only after the original documents are provided showing the working with children
card and a receipt for the photo.
The section relating to the organisation where the results are sent to is to have:
1) address 38 Blakeville Dr, Caroline Springs VIC, 3023 and
2) phone number 03 8621-6977.
Part 2 – Declaration of Coaches and Administrators
If the person cannot truthfully sign the statutory declaration, he or she must not continue to be involved
as a coach or administrator but may write to the Secretary of the CSBDBC explaining why the
declaration cannot be signed. The CSBDBC committee will treat the matter as strictly '‘private and
confidential'’ and decide whether the person may resume as a coach or administrator.
Part 3 – Police Check
Results of the police check will be sent to the Secretary. If there is an adverse report about a person
then that report will be treated as strictly '‘private and confidential'’ and the CSBDBC committee will
decide whether the person may resume as a coach or administrator.
Declaration of Coaches and Administrators (SAMPLE DECLARATION)
I, ………………………………………………………. (name) of
………………………………...……………………….
……………………………………….………………… (address)
solemnly and sincerely declare:
born
/
/
1. I am an applicant coach/coach/assistant coach/administrator for basketball conducted by
the Keilor Basketball Association.
2. I have never been charged with any criminal offence relating to narcotics, violence or
abuse (including sexual abuse).
3. 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).
4. No application has been rejected, nor have I been suspended or dismissed from a position
in sport, other volunteer organisation, business, educational or other Government or semigovernment organisation where that rejection, suspension or dismissal relates to my conduct
with persons aged under eighteen (18) 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.
I make this declaration that the information contained in it is true and correct and I make it in
the belief that a person making a false declaration is liable to the penalties of perjury.
Declared at 2:37pm, in the State of Victoria this
……………..………….. (signature)
3rd
day of
January 20
Witnessed by: John Doe (name) of Taylors Lakes, VIC, 3038 (address)
……………..………….. (signature)
(to be witnessed by a person qualified to take statutory declarations)
Statutory Declarations may be made before:
 A Justice of the Peace or a Bail Justice
 A Notary Public
 A Barrister and Solicitor of the Supreme Court of Victoria
 A Clerk to a Barrister and Solicitor of the Supreme Court of Victoria
 The Prothonotary or a Deputy Prothonotary of the Supreme Court of Victoria
 Registrar or Deputy Registrar of the County or Magistrates’ Courts, or of Probate
 Associate to a Judge of the Supreme or County Courts
 Secretary to a master of the Supreme or County Courts
 A Patent Attorney
 Member of the Police
 The Sheriff or a Deputy Sheriff
 Current or former Member of Parliament of Victoria or the Commonwealth
 Councillor or senior officer of a Council
 Medical Practitioner
 Dentist
 Veterinary Surgeon
 Pharmacist
 School Principal
 Manager of an approved deposit taking institution (bank)
 An Accountant who is a member of the Institute of Chartered Accountants, the Society of CPAs or the National Institute of Accountants
 The Secretary of a Building Society
 A Minister of Religion who is authorised to perform marriages
 A Senior Victorian Public Servant
 A Member of the Institute of Legal Executives
Declaration of Coaches and Administrators
I, ………………………………………………………. (name) of
………………………………...……………………….
……………………………………….………………… (address)
solemnly and sincerely declare:
born
/
/
1. I am an applicant coach/coach/assistant coach/administrator for basketball conducted by
the Keilor Basketball Association.
2. I have never been charged with any criminal offence relating to narcotics, violence or
abuse (including sexual abuse).
3. 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).
4. No application has been rejected, nor have I been suspended or dismissed from a position
in sport, other volunteer organisation, business, educational or other Government or semigovernment organisation where that rejection, suspension or dismissal relates to my conduct
with persons aged under eighteen (18) 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.
I make this declaration that the information contained in it is true and correct and I make it in
the belief that a person making a false declaration is liable to the penalties of perjury.
Declared at
, in the State of Victoria this
……………..………….. (signature)
Before me:
day of
(name) of
……………..………….. (signature)
(to be witnessed by a person qualified to take statutory declarations)
20
(suburb)
Statutory Declarations may be made before:
 A Justice of the Peace or a Bail Justice
 A Notary Public
 A Barrister and Solicitor of the Supreme Court of Victoria
 A Clerk to a Barrister and Solicitor of the Supreme Court of Victoria
 The Prothonotary or a Deputy Prothonotary of the Supreme Court of Victoria
 Registrar or Deputy Registrar of the County or Magistrates’ Courts, or of Probate
 Associate to a Judge of the Supreme or County Courts
 Secretary to a master of the Supreme or County Courts
 A Patent Attorney
 Member of the Police
 The Sheriff or a Deputy Sheriff
 Current or former Member of Parliament of Victoria or the Commonwealth
 Councillor or senior officer of a Council
 Medical Practitioner
 Dentist
 Veterinary Surgeon
 Pharmacist
 School Principal
 Manager of an approved deposit taking institution (bank)
 An Accountant who is a member of the Institute of Chartered Accountants, the Society of CPAs or the National Institute of Accountants
 The Secretary of a Building Society
 A Minister of Religion who is authorised to perform marriages
 A Senior Victorian Public Servant
 A Member of the Institute of Legal Executives