Please list your interests, skills and any relevant experience
Do you have any expertise or training that will assist the volunteer group? If yes, please provide details.

Which category best describes your current activities?
Full time employment - Home Duties - Retired - Part time employment - Student - Unemployed - Other

When are you available for volunteering?

Day	Mon	Tues	Wed	Thurs	Fri	Sat	Sun
Time/ s:

Medical Information:
Are you on Workers Compensation or Sick Leave? Yes/ No

Do you have any medical restrictions, health issues or allergies that may affect your volunteering tasks?
If yes, please provide details

Do you have a disability that may restrict the types of tasks that you can do?

Are you taking any medication that may be important for us to know about? (e.g. heart tablets or insulin) If yes, please provide details

Do you have any inoculations as a safeguard against diseases? (e.g. tetanus) If yes, please provide details (e.g. type and date):

Working with Children and Young People
If you would like to participate in volunteer activities that involve working with children and young people under 18 years of age, please advise if you are a prohibited person under (your state's) child protection legislation.

Do you have any objection to the organisation undertaking a "working with children"/ "police check" ? (Note: different states use different wording for these types of checks)

Signature & Date

Parent's/ Guardian's Signature (if aged under 18)