ICF Safeguarding Policy Compliance Form

Annex 5: ICF Council Members & ICF Staff Safeguarding Policy Compliance Form

Name

Phone Number

Email Address

Which ICF service do you attend?

ICF South ICF North

What is your role at ICF?

Council Member Pastor Associate Pastor Administrator

Do you have an up-to-date police check from your passport country?

Yes No

Which country is your police check from?

Do you have an up-to-date police check from Cambodia?

Yes No

Have you got a Child Protection Training Certificate dated within the last 2 years?

Yes No

Declaration
I have read the ICF Safeguarding Policy and I understand that it is my duty to protect the children, young people and vulnerable adults with whom I come into contact. I agree to fully comply with the policies and procedures agreed by the Church for the protection of children, young people and vulnerable adults.

I agree to the declaration statement above.

Signed (Type Name as Digital Signature)

Name of Signatory