Volunteer Registration Form

Volunteer Application Form

Please complete and submit the below form if you would like to become a volunteer for the safe shelter in Ulladulla. We will be in contact with you shortly and appreciate your support.
Full Name *

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
E-mail *
Phone Number *
Date of birth *

Day Month Year
Date
Gender *

Male Female
Are you a member of a church? If so, which one?

Preferences in Availability:

4pm - 10pm

10pm - 9am

Day time

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Preferences in Duties

Please tick

Cooking meals

Serving meals

Mentoring

Overnight shifts

Cleaning

Spending time with people

Any Special Comments
Emergency Contact Details
Name *

First Name Last Name
Relationship
Phone Number *
Other Information
Do you have a drivers license? *

Yes No
Do you have First Aid Qualifications? *

Yes No
Do you have Mental Health First Aid Qualification? *

Yes No
Working With Children Check (WWCC)
https://www.service.nsw.gov.au/transaction/apply-working-children-check
Do you have a WWCC? *

Yes No
What is your WWCC number? *
WWCC Number
WWCC Expiry Date: *

Month Day Year
WWCC Expiry Date
Do you have any medical issues that may impact on your volunteer work? *
How often would you like to volunteer?:

1 night per week 1 night per fortnight 3 weekly 1 night per month
What previous volunteering / experience do you have and with who?
Other information (include prefered nights here e.g every 2nd Tues and any relevant qualifications here):
I hereby agree that the personal information on this form will be used for the purposes related to Safe Waters Community Care Inc. safe shelter project. This information will not be disclosed outside of this. I understand that my volunteer duties may require a police check. *
Please sign/print your name here
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Volunteer Application Form