Want to get involved and help someone in need?

Name

First Name

Last Name

Phone

Please provide the most convenient phone number to get in touch with you :)

(###)

###

####

Tell us about yourself and why you want to get involved?

DOB DD/MM/YYYY

Gender

Emergency Contact

Medicare #

Parent/ Guardian Details (If Under 18)

Parent Name

Parent Email

Parent Phone

Last Tetanus Shot?

Are you on any Medication?

Do You have ambulance insurance?

Do you have any of the following?

Asthma

Anxiety

Behavioral Issues

Epilepsy

Hearing impairment

Sight impairment

Physical Ability

Is there anything else we should be aware of?

Referee Email Address

An email will be sent to this person, please ask them to give a small write up about yourself to give us more insight into who you are.

Mode of transport?

Availability?

Skill Set? Any qualifications?

are you willing to offer prayer? help the hospitality team? Do discipleship? worship?

Are you currently attending a church? Which one?

Can you provide a reference from your minster?

Do you have a valid working with children police check? if so can this be provided?

Permission and Indemnity (print name)

I indemnify the organisers, organisation and fellow participants of any consequences and sequelae from participating in this voluntary activity. I understand that all the activities partaken in are intended for the good of others and done in a manner as best seen at the time. In the case of a medical emergency I give permission to attain medical assistance for myself/child. I understand that every effort will be made to contact me prior to initiating such. I permit myself/ child to be transported as may be required in emergency circumstances. Personal details will remain confidential and will not be provided to others except as may be required by Law.

Do you agree to these conditions?

yes