EmailMe Form - VOLUNTEER REGISTRATION FORM

Personal Details

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country

Postal Address

Suburb

State

Post Code

Country

Email Address

Phone Number

Mobile Number

Date of Birth

DD / MM / YYYY

Country of Birth

Do you identify as Aboriginal/Torres Strait Islander

Yes

No

Do you have any health or medical condition

Yes

No

Please give details

Do you have access to transport

Yes

No

How did you find out about volunteering

SITUATION PROFILE

Job Network Provider

Other

GENERAL INFORMATION

Have you been a volunteer before

Yes

No

What type of volunteering activities most inerest you

VISAS & vOLUNTEERING FOR OVERSEAS VISITORS

Do the terms & conditions of your visa permit you to undertake voluntary work

Yes

No

Unknown

WORKCOVER & OCCUPATIONAL REHABILITATION CLIENT

Are you looking to undertake volunteering as work experience under an occupational rehabilitaion program &/or at the suggestion of your case-worker

Yes

No

Do you allow us to communicate with your case-worker about insurance cover

Yes

No

Please provide name and contact details of your case-worker

Name

First Last

Phone

Email

GENERAL

Are you interested in volunteering for one-off activities or events

Yes

No

Are you willing to be included in publicity by Volunteering Central West or Volunteering Australia to promote volunteering

Yes

No

May we provide you contact details to Volunteering Australia and Australian Department of Education, Employment and Workplace Relaions

Yes

No

If we refer you to an organisation, the organisation will decide whether or not it can involve you as a volunteer, it will not be the decision of Volunteering Bathurat or Volunteering Central West. Do you understand

Yes

No

I agree that the information recorded above is true and correct

Yes