Volunteer Registration Form (incl Spontaneous Bushfire fighter) FCEO067

Volunteer Registration Form (incl Spontaneous Bushfire fighter) FCEO067

Volunteer Given (Preferred) Name(s)*

Volunteers Surname*

Telephone No.

Phone

Mobile #*

Phone

Email Address*

Please enter your date of birth in the format 01/01/2001*

Volunteers under the age of 16 require Parent or Guardian Approval If under 16 or over 91 please make enquiries with the Shire

Residential Address*

Postal Address*

if the same as Residential type 'As Above'.

Volunteering Area(s) of Interest*

Please select as many as you wish to be considered for.

Spontaneous Bush Vire Volunteer (one off)

Health Issues*

Please provide health and medical information that may affect your participation and/or is important in the case of a medical issue or emergency Do you have any medical conditions, allergies, disabilities, part or present injuries that may affect your participation?

Select

If Health Issues - Describe

If yes, please provide details.

Emergency Contact Info - Name*

Please provide at least one emergency contact should you require assistance or have a medical issue while volunteering.

Emergency Contact Info - Relationship to Volunteer*

Select

Emergency Contact Info - Mobile*

Phone

Additional Info - Police Clearance*

I am able to attain a National Police Clearance if required (cost reimbursed by the Shire).

Yes

Additional Info - WWC Check*

I have or am able to obtain a current Working with Children Check, for which I can provide a copy of if required (cost reimbursed by the Shire).

Yes

Drivers License Class(es) - if applic

Drivers License Expiry Date*

I have a current ‘C’ Class driver’s license for which I can provide a copy of if required.

Additional Info - List eg First Aid*

Other (e.g. First Aid Certificate, F Class Drivers Licence etc.)

Other Info*

Is there anything else we should know that will support you to have a positive volunteering experience?

Declaration by Volunteer (18 or over)

I have been informed of the Code of Conduct for Employees and Volunteers and accept my obligations under this Code including the requirements for maintaining privacy and confidentiality. I sign this declaration acknowledging that all statements and information given on this form are true and correct and I will abide by Council Policies and Management Policies and all reasonable and lawful instructions given to me by Shire employees or a Volunteer Supervisor.

Parent / Guardian Contact Name(s) (if u/18)

Parent/Guardian - Mobile No.

Phone

Declaration by Parent/Guardian (if under 18)

By completing the information below I consent to my child/dependent volunteering for the Shire of Narrogin.

I have been informed of the Code of Conduct for Employees and Volunteers and accept my child/dependents obligations under this Code. I sign this declaration acknowledging that all statements and information given on this form in regards to my child/dependent are true and correct.

Send me a copy of my responses

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