MEMBERSHIP APPLICATION FORM
THIS APPLICATION IS FOR? *
 New membership application 
 Renewal of annual membership 
Date of application *

DD		/
MM		/
YYYY

Personal Information

NAME: *
Prefix
First *
Last *
Suffix
ADDRESS *
SUBURB *
HOME PHONE NUMBER: *
MOBILE NUMBER
EMAIL: *
CHILD(RENS) NAME:
CHILD(REN) YEAR / CLASS:

IDENTIFICATION REQUIREMENTS FOR WORKING WITH CHILDREN CHECK

DATE OF BIRTH *
PLACE OF BIRTH *
COUNTRY OF BIRTH *
DRIVERS LICENCE NUMBER: *
STATE DRIVERS LICENCE ISSUED IN: *

AREAS OF INTEREST:

Please let us know in a few words what areas of P&C you might wish to participate in (ie: meetings, fundraising, canteen, clothing pool, fete)
Do you have any special skills you might like to let us know about that you might like to use for P&C?

THE NSW COMMISSION FOR CHILDREN AND YOUNG PEOPLE

WORKING WITH CHILDREN CHECK AND VOLUNTEER DECLARATION

You are required to make a prohibited person declaration when working with children, even in a volunteer capacity.

PROHIBITED PERSON WORKING WITH CHILDREN DECLARATION *
  I declare I am not a Prohibited person under the Commission for Children and Young Persons Act 1998 (NSW). 
It is an offence for a prohibited person to apply for, attempt to obtain, undertake or remain in child-related employment, including a volunteer role. A prohibited person is a person who is convicted of the following (whether in NSW or elsewhere):

* murder of a child
* serious sex offence, including carnal knowledge
* child-related personal violence offence (an offence committed by an adult involving intentionally wounding or causing grievous bodily harm to a child)
* indecency offences punishable by imprisonment of 12 months or more
* kidnapping (unless the offender is or has been the child's parent or carer)
* offences connected with child prostitution
* possession, distribution or publication of child pornography; or
* attempt, conspiracy or incitement to commit the above offences.

A prohibited person includes a Registrable person under the Child Protection (Offenders Registration) Act 2000.

Details of these offences can be found online at Working With Children Employer Guidelines Fact sheet 1. A conviction includes a finding that the charge for an offence is proven, or that a person is guilty of an offence, even though the court does not proceed to a conviction

DECLARATION OF WORKING WITH CHILDREN STATUS: *
 Yes, I agree I am not a prohibited person under any legislation. 
I have read and understood the information above about prohibited persons. I am aware that it is an offence to make a false statement on this form about my prohibited from working with children status.

CONSENT FOR WORKING WITH CHILDREN CHECK:
 Yes, I agree. 
I consent to the Commission for Children and Young People checking my relevant criminal records, to verify these statements. I understand that this information may be referred to the Commission for Children and Young People and/or to NSW Police for law enforcement purposes and for monitoring and auditing compliance with the procedures and standards for the Working With Children Check in accordance with Section 36 (1)(f) of the Commission for Children and Young People Act 1998.

YOU MUST PAY YOUR ANNUAL SUBSCRIPTION BEFORE YOUR MEMBERSHIP APPLICATION WILL TAKE EFFECT.

I understand that once I submit my form, my annual membership cannot commence until such time as I have paid my annual subscription fee to the Treasurer. *
 Yes, I agree. 
YOUR ANNUAL MEMBERSHIP FEE SHALL FALL DUE FOR RENEWAL AT THE CLOSE OF THE ANNUAL GENERAL EACH MARCH.

ASSOCIATION RULES AND REGULATIONS

I certify I understand the rules and gudelines that govern our Association are set out according to the Constitution, By-Laws, Code of Conduct, and Harassment and Discrimination Policies.

I agree all of the above is true and correct and I hereby apply for annual membership. *
 Yes, I agree. 
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