Athletics Alberta Statutory Declaration Form

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Athletics Alberta Statutory Declaration Form Powered By Docstoc
					                               Track & Field, Cross Country, Road Running
                               11759 Groat Road, Edmonton, AB T5M 3K6
                               Ph: (780) 427-8792 • Fax: (780) 427-8899
                               Email: info@athleticsalberta.com • Website: www.athleticsalberta.com

                               Athletics Alberta Statutory Declaration Form



I, ____________________________________, of _________________ in the Province of Alberta,
solemnly declare:


                                       I do not have a criminal record.

                                       I have never failed to pass a security clearance check.

                                       I have never had a restraining order imposed upon me.

                                       I am bondable.

                                       I am not an un-discharged bankrupt.


I make this solemn declaration conscientiously believing it to be true and knowing that it is of the
same force and effect as if I made it under oath.


       _____                 __________________ ______
                        (Signature of Nominee)                                      (Date)



       _____                 __________________ ______
                        (Printed Name of Nominee)




       _____                 __________________ ______
                        (Signature of Witness)                                      (Date)


       _____                 __________________ __________
                        (Printed Name of Witness)




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