Love your place volunteer application form

LOVE YOUR PLACE VOLUNTEER CLEAN-UP PROGRAM

CITY OF CANADA BAY COUNCIL

The volunteer clean-up program promotes community litter clean-ups through an organised volunteer program where residents get to nominate a park or street. The program focuses on volunteers working together to remove litter and report illegal dumping, graffiti, damaged facilities and anti-social behaviour in the nominated site. The nominated sites are Council approved public spaces such as parks, foreshore areas and local streets.For further information or questions regarding this form, please contact Council via 9911 6555.

Volunteer details

Surname *

First Name *

Group name

Address *

Postcode *

Phone (H)

Phone (W)

Phone (M) *

Email *

Please specify days and times you will be conducting the clean up: *

How often will you be cleaning each year? *

One offRecurring throughout the year

Do you have any pre-existing medical conditions or special needs/allergies that may affect the type of work you do as a volunteer? *

YesNo

Please outline condition/s and restrictions on work. *

I give permission for photographs of me to be used in various City of Canada Bay Council publications? *

YesNo

Details of the site being adopted

Site name: *

Site address: *

Please indicate if your site will be open to the community or private. *

Open Private

Open: sites open to the wider community to participate and may be promoted by Council
Private: not promoted by Council and volunteers only able to participate by invitation from the Site Supervisor

Emergency Contact person

Emergency contact full name: *

Relationship:

Phone (H):

Phone (M): *

Declaration

I commit to being an active Love Your Place volunteer and am willing to help fulfil the purposes of the program. I confirm that I have read and understood the terms and conditions outlined in Council’s Volunteer Information Package and the COVID safe plan.

Applicant Signature *

Draw signature|Type signatureClear

Date signed *