Duke of Edinburgh Volunteer Registration Form

DUKE OF EDINBURGH

LIBRARY 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 02 9911 6381.

First Name *

Surname *

Address *

Postcode *

Mobile Number *

Date of Birth *

Email Address *

Name of School *

School Contact *

Emergency Contact Full Name *

Relationship to Applicant *

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 volunteering? *

Yes No

Please provide details *

Are there any adjustments required for you to successfully complete your volunteering? *

Yes No

If yes, please provide details *

What level of Duke of Edinburgh are you completing? *

BronzeSilverGoldN/A: Other School Volunteer Program

What is the time period required to complete the volunteer portion of your program? *

What date do you need to complete your volunteering by? *

Any additional commentsIf required