Bushcare Volunteer Registration Form

BUSHCARE VOLUNTEER REGISTRATION FORM

Information provided on this form will not be released to anyone outside of Council without the express permission of the individual concerned.

For further information or questions regarding this form, please contact Council via 9911 6555.

First Name *

Surname *

Address *

Postcode *

Mobile Number *

Date of Birth *

Email Address *

Emergency Contact Full Name *

Emergency Contact Address *

Emergency Contact Postcode *

Emergency Contact Mobile Number *

Emergency Secondary phone number If applicable

Do you have any medical conditions that may affect your ability to carry out Bushcare Activities? *

Yes No

Please provide details *

Would you like to be an active volunteer? *

Yes No

Would you like to receive information on activities/events? *

Yes No

I have read and understood the following Bushcare documents:

I have read and completed the Bushcare Volunteer Induction Kit and understand my legal obligations and the conditions under which I will volunteer.

Full name: *

Date signed *

Applicant Signature *

Draw signature|Type signatureClear