Register - Margaret River Heart

First name *

Last name *

Email *

Phone *

Date of Birth *

Address *

Postcode *

State *

Emergency Contact *

Relationship *

Emergency Contact Phone *

Please indicate a size for a HEART Volunteer Polo Shirt *

Volunteer Interests *

Availability - Please indicate all days you are available *

Please indicate the times you are available for both day and evening activities *

Experience - Do you have any experience in the following roles? *

The following information will assist us in providing guidance and support.

Do you have any other experience that may benefit the HEART? If yes, please specify:

Certificates - Do you have any of the following certificates: *

Responsible Service of Alcohol (RSA)

Current First Aid

Working With Children Check

National Police Clearance (obtained within the last 3 months)

None of the above

The following information will assist us in allocating appropriate volunteer activities.

Medical Information - Do you have any medical conditions that may affect your ability to perform volunteer activities, including injuries, illness or allergies? *

The following information will assist us in allocating safe and suitable volunteer duties

If yes, please provide further informtion, including the nature of the condition and any medicaton you may carry:

Do you identify as a person with a disability? *

If yes, would you like to register a Carer / Support worker to attend with you?

Volunteer Agreement - By ticking this box and printing my full name and date below, I hereby register to become a volunteer for the Shire of Augusta Margaret River's HEART venue, and in doing so, I agree to do the following: *

Declaration

I understand that there is no remuneration associated with volunteer work and that this application does not constitute a contract of employment, nor does it guarantee a volunteer position. I understand that the information I provide will only be available to venue management and that it may only be used for it’s attended purposes. agree to participate in a Volunteer Induction and adhere to the codes of conduct, policies and procedures presented to me. I agree to attend all shifts that I accept with venue management. If I am unable to attend a shift, I will advise HEART at the earliest possible opportunity. I am responsible for my personal property, including my vehicle, and HEART will not accept responsibility for any loss or damage. I am responsible for wearing appropriate clothing and footwear and maintaining a neat and tidy appearance while conducting volunteer activities. I agree to follow the direction of my supervisor and / or venue management at all times when performing volunteer duties. I acknowledge that any statement which is found to be false or deliberately misleading could lead to my application being declined or terminated at any time.

Please Print Full Name *

Date *

Volunteer with HEART Information & Application

Welcome!

Volunteer Application Form