Criminal Record Declaration

By completing and submitting this form you are declaring that your Criminal Background has not changed in the past year.

Name

Date (mm/dd/yyyy)

Position

I declare that my CRIMINAL BACKGROUND CHECK has not changed since my last submission (must be within 3 years)

True

False

What Division of Play

If Applicable - What Division for Player #2

If Applicable - What Division for Player #3

If Applicable - What Division for Player #4

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