Spontaneous Emergency Volunteer Registration Form
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Title *


 
Name:

 
Address:

 
Local Government Area (LGA): *


 
Best contact telephone:

 
Email:

 
Languages spoken:

 
Preferred Emergency Volunteer Role: *


 
If you selected OTHER please provide a description:

 
What skills can YOU offer during/ following an emergency?

 
If you have any issues relating to health concerns/ disabilities/ current treatment/ locations or other, please specify as these may prevent you from performing particular duties

 
Do you have a current articulated licence

     
 
Do you have a current first aid certificate

     
 
Do you have a current food handlers certificate

     
 
Are your immunizations up to date?

     
 
Do you have a mental health first aid certificate

     
 
Do you have a current police check

     
 
Do you have a current working with children's check

     
 
Bendigo Volunteer Resource Centre will not disclose private or confidential information to third parties without your consent.

 
DECLARATION:
I agree to the relevant information provided on this form being given to the Northern Victorian Integrated Cluster in order to make an appropriate volunteer role match, and that some of my information may be used for statistical data *

     
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