Volunteer Application Form

Volunteer Application Form
Personal Details

All information shared is treated confidentially
Name*

First NameLast Name
Preferred Name
Email Address*
Phone Number*

Area CodePhone Number
Identity Number
Date of Birth

MonthDayYear
Gender

MaleFemale
Marital Status

MaleFemale
Race
(statistical purposes only)
Nationality
Religious Affiliation
(used to match prayer families)
Home address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Postal Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Drivers Licence

YesNo
Own transport

YesNo
Police Clearance Certificate Attached (Compulsory)

YesNo
Attach

Upload a File

Cancelof
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

YesNo
Fainting Spells

YesNo
Epilepsy

YesNo
High/Low Blood Pressure

YesNo
Other
Emergency contact details
Name

First NameLast Name
Relationship
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone 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 FamilyTherapy ServicesIn Hospital ServicesAngel SupportFundraising/EventsBloggingAdministrativeWarrior SupportChemoPal/BuddyCooking/DeliveriesNew Diagnosis SupportBrand SupportOther
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 CodePhone Number
E-mail
Address
REFERENCE 2
Name
Position
Phone Number

Area CodePhone 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.
Should be Empty:

Volunteer Application Form

Personal Details

Training, Qualifications, Natural Gifts and/or Talents

Previous Volunteer Work or Work History

Do you currently (or have you ever) suffered from any of the following?

Emergency contact details

What has motivated you to want to volunteer for the My Child Has Cancer Trust?

References