Georges River Council - Online Forms

VOLUNTEERING APPLICATION FORM

Title:*

MrMrsMsMiss

Name:*

Surname:*

Contact Number:*

Email:*

Language Spoken:*

Address

Unit/Street Number:*

Street Name:*

Suburb:*

Postcode:*

Age Group

Please Select Age Group:*

Up to 18 years
19 to 34 years
35 to 64 years
65 +

Note: If applicant is under the age of 18, this volunteer application form must be co-signed by a parent or guardian. The volunteer must be supervised at all times by a responsible adult.

Emergency Contact Details

The applicant must provide emergency contact details if in the event of an emergency and Council is required to notify a responsible person, nominated below.

Name:*

Surname:*

Relationship:*

Contact Number - 1:*

Contact Number - 2:*

Please indicate session availability for last Wednesday of the month between 10.00am to 12.00pm:

Please Select:*

26 August 2020
30 September 2020
25 November 2020

Do you have any disabilities or medical conditions which may affect you onsite?

Any Disabilities:*

No
Yes

If yes, what are medical conditions details:

I authorise Georges River Staff to seek emergency treatment for me in case of an accident, injury or illness?

Emergency Treatment:*

No
Yes

What is your motivation to undertake volunteer work?

Select Motivation:*

Permission to use images in various Georges River Council publications and social media:

Permission to use images:*

No
Yes

Signature

Please print name as acceptance.

Full Name:*

Parent Signature

Parent Signature is required if the applicant is under 18 years of age. Please print name as acceptance.

Full Name:

Security code:*

Privacy Disclaimer

Your personal information is being collected by Council in accordance with applicable legislation.

The provision of your personal information is voluntary, however the information assists Council in the delivery and management of the subject request, and / or as required by law.

Your personal information will be used and disclosed for the Council’s purposes, or a directly related purpose, unless you consent to another use or disclosure, in emergencies or as otherwise required or authorised by law.

Should you wish to access or amend your personal information please make a written request to Council by:

Post: PO Box 205, Hurstville BC NSW 1481
Email: mail@georgesriver.nsw.gov.au

For more information please refer to Council’s Privacy Management Plan.