Statutory Declaration

Working With Children Check - Declaration for Volunteers and Non-Child-Related Contractors
Name(Required)
DD slash MM slash YYYY

I declare: 

1. a) I am in child-related work or applying to be in child-related work within the meaning of the NSW Child Protection (Working with Children) Act 2012, but am exempt from the requirement to hold a working with children check clearance under the Child Protection (Working with Children) Regulation 2013 at the time of the making of this declaration. 

or b) I am a non-child-related contractor within the meaning of the NSW Child Protection (Working with Children) Act 2012 at the time of the making of this declaration. 

2. I have not had a working with children check cancelled, refused nor am I subject to an interim bar on engaging in child-related work under the Child Protection (Working with Children) Act 2012 (this declaration may be made if a clearance was subsequently granted to you, a clearance was surrendered by you or the cancellation was overturned on review). 

3. I declare that I am not a disqualified person within the meaning of Section 18 of the NSW Child Protection (Working with Children) Act 2012. 

4. I have not been convicted of an offence, or subject to a finding of guilt for an offence or a finding that the charge for an offence is proven, where the offence was committed as an adult in NSW or elsewhere and was an offence of the kind set out in the list of offences at the end of this declaration. 

5. I undertake, as a condition of my continuing to perform work (including volunteering) for Feel the Magic, that I will notify them of: 

a. the cancellation, refusal to be granted or imposition of an interim bar of any clearance I may hold under the NSW Child Protection (Working with Children) Act 2012 that would prevent me from engaging in child-related work that requires a working with children check clearance; b. any conviction imposed on me for an offence, or finding that I am guilty of an offence, or finding that the charge for an offence against me is proven, where the offence is of the kind referred to in the attached Declaration. 

6. I am aware that providing false or misleading information in this document may lead to Feel the Magic: a. withdrawing any offer of engagement that it has made to me; or 

b. terminating my engagement, and 

c. considering any false or misleading information I provide, when considering any future applications by me for employment or engagement

Consent(Required)

List of offences 
As referred to on page 1 of the Declaration: 
a) a sexual assault or intercourse offence;
b) the common law offence of rape or attempted rape;
c) an indecent assault offence;
d) a sexual servitude offence;
e) observing a person engaged in a private act, for the purpose of obtaining sexual arousal or
sexual gratification (voyeurism);
f) filming another person engaged in a private act or filming another person’s private parts, for
the purpose of obtaining, or enabling another person to obtain, sexual arousal or sexual
gratification;
g) installing a device, or constructing or adapting the fabric of a building, for the purpose of
facilitating the observation or filming of a child, with the intention of enabling any person to
commit an offence referred to at (d)-(e) above;
h) murder of a child;
i) manslaughter of a child (other than as a result of a motor vehicle accident);
j) intentional wounding or causing grievous bodily harm to a child who was three or more
years younger than me;
k) a child prostitution offence;
l) an offence involving an act of indecency with or towards a child;
m) procuring or grooming a child under 16 years of age for unlawful sexual activity;
n) using a child for the production of child abuse material, or producing, disseminating,
possessing or importing child abuse material;
o) possessing or importing child pornography;
p) offences relating to the use of a postal or similar service for child pornography material or
child abuse material;
q) offences relating to the use of a postal or similar service involving sexual activity with a
child under 16;
r) publishing indecent articles;
s) an offence of kidnapping a child, unless a parent or carer of the child at the time of the
offence;
t) a forced labour or deceptive recruiting for labour or services offence, where the victim was
a child;
u) intentional or reckless infliction of grievous bodily harm on a child, during or after the
delivery of the child;
v) intentionally abandoning or exposing a child under the age of seven;
w) bestiality;
x) an offence an element of which is an intention to commit one of the above offences; or
y) an offence of attempting, or of conspiracy or incitement, to commit one of the above
offences.