Volunteer Application Form

Home address

Postal Address

Drivers Licence

Yes No
Own transport

Yes No
Police Clearance Certificate Attached (Compulsory)

Yes No
Attach
Training, Qualifications, Natural Gifts and/or Talents

This information is used to assist us to determine in which ways we are able to make use of your service
Describe your skills and talents
Previous Volunteer Work or Work History
Do you currently (or have you ever) suffered from any of the following?
Clinical Depression

Yes No
Fainting Spells

Yes No
Epilepsy

Yes No
High/Low Blood Pressure

Yes No
Other
Emergency contact details
Name

First Name Last Name
Relationship

Address

Phone Number

Area Code Phone Number
E-mail
What has motivated you to want to volunteer for the My Child Has Cancer Trust?
Explain your motivation
Preferences in Volunteering

Host/Care Family Therapy Services In Hospital Services Angel Support Fundraising/Events Blogging Administrative Warrior Support ChemoPal/Buddy Cooking/Deliveries New Diagnosis Support Brand Support
Available Dates and Times
(e.g every Monday from 10 until 12 for 6 months)
References

Due to the nature of the work you will be doing, we conduct references on all our volunteers. Please provide names, addresses and telephone numbers of two referees, preferably one employer and NOT family members.
REFERENCE 1
Name
Position
Phone Number

Area Code Phone Number
E-mail
Address
REFERENCE 2
Name
Position
Phone Number

Area Code Phone Number
E-mail
Address
References *

I declare that the information presented above is accurate and that I am prepared to allow the above referees to be contacted in respect of the voluntary position(s) I am interested in.
Confidentiality *

I accept the responsibility of keeping all aspects of the work of the My Child Has Cancer Trust in highest confidence.
Indemnity *

The My Child Has Cancer Trust cannot be held responsible for any injuries/accidents that happen to me while I am on duty. If any accident should occur, I hereby authorise the My Child Has Cancer Trust to contact my emergency contact as listed on my volunteer application form.
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