Ts4_volunteer_application_form

Volunteer Application Form
PERSONAL DETAILS Male / Female
Name: _______________________________________ Address: _____________________________________ Suburb: ______________________________________ City: _________________________________________ Tel: _______________________________________ Mobile: ____________________________________ Referee 1 contacted Yes / No Date: ________________ Date of Birth: _________/__________/______________ Contacted by: ___________________________________ E-mail: _______________________________________ Comments: _____________________________________ Job/Study: ____________________________________ _______________________________________________ Referee 2 contacted Yes / No Date: ________________ PERSONAL FAITH INFORMATION
Contacted by: ___________________________________ How would you describe your Christian faith at present? Comments: _____________________________________ _____________________________________________ _______________________________________________ _____________________________________________ REFEREE DETAILS
_____________________________________________ Give the contact details of two people who may be _____________________________________________ contacted regarding your character and suitability. Please _____________________________________________ let your referees know that someone from Scripture Union will be contacting them. _____________________________________________ _____________________________________________ Name: _________________________________________ DETAILS OF CHURCH YOU ATTEND
p: _______________________________________ (Work) Name:________________________________________ p: ______________________________________ (Home) Denomination: _________________________________ Referee Two - other (friend, employer, teacher, not family) Current involvement in church: ____________________ Name: _________________________________________ _____________________________________________ p: _______________________________________ (Work) _____________________________________________ p: ______________________________________ (Home) How long have you attended this church?____________ REASON FOR APPLYING TO BE A LEADER
Name of person we may contact to pray for you while Briefly describe why you are applying to be part of the _____________________________________________ _______________________________________________ Email: ________________________________________ _______________________________________________ _______________________________________________ _______________________________________________ What are your gifts, talents, skills and strengths? _______________________________________________ _____________________________________________ _______________________________________________ _____________________________________________ _______________________________________________ _____________________________________________ _______________________________________________ _____________________________________________ _______________________________________________ Role you are applying for? ________________________ _______________________________________________ If that role is already filled would you be willing to do a _______________________________________________ _______________________________________________ First Aid Qualified Yes / No Date it expires:_________ _______________________________________________ MEDICAL INFORMATION
To assist us with any illness or accident and emergency treatment you may require while involved with our activities please supply the following:
Are you allergic to Penicillin? Yes I No Do you have any other allergies? Yes I No Please give details below: ______________________________________________________________________________________________ Do you take any regular medication that should be known about in the event of an emergency? Yes / No Please give details: _______________________________________________________________________________ Tetanus booster? Yes I No Date of last booster: ________________________ Doctor’s Name: ________________________________ Doctor’s Phone #:___________________________________ Do you require a special diet? Yes I No Please give details: ______________________________________________ Do you have a physical disability or, a psychological or medical condition that may affect your ability to fully participate as a leader? Yes I No Please give details: ____________________________________________________________ _______________________________________________________________________________________________ _______________________________________________________________________________________________ YOUR COMMITMENT

I ______________________________________________________________________________________________
1. have prayerfully considered this application and offer myself for Christian service through Scripture Union. 2. have a living faith in Jesus Christ as Saviour and Lord and a love and devotion to Him. 3. agree to attend all meetings, training events and perform all other duties required, acknowledging the authority of leadership within the Scripture Union Movement and am aware of financial implications of having to pay my own way and obligations in volunteering for Christian service. 4. recognise and accept responsibilities of working co-operatively in a team with people from various denominations in 5. recognise and accept the challenges that I may face working with children who are from different cultural and/or 6. have contacted my referees and let them know that a person from Scripture Union will contact them regarding my 7. have NOT been convicted of any offence involving children, young people, violence, alcohol or drugs and have completed a 'Consent For Disclosure Of Information' form (17 years old or older) and give my permission for it to be sent to the New Zealand Police to be vetted. 8. have NOT been interviewed, questioned or charged by police in relation to any offence involving children, young people, violence, alcohol or drugs. (If you have please provide details on a separate sheet.) 9. agree that any photographs taken at camp with me in them may be used for future camp publicity. 10. agree that the information contained in this application is correct to the best of my knowledge. Signature: ______________________________________________________________________ If you are under 18 years of age a parent or guardian must sign too
Signature of Parent or Guardian: _________________________________________________________________ All information provided remains confidential to activity directors, Scripture Union and Prison Fellowship staff
EMERGENCY CONTACT (NEXT OF KIN)
Name: ________________________________________________ Relationship to you: ________________________ Address: _______________________________________________________________________________________ Phone Day: ____________________ Night: __________________ Mob: ___________________________ Please return form to: SUPAkidz Camps, P O Box 8517, Symonds Street, Auckland 1150

Source: http://www.scriptureunion.org.nz/files/general/chilfam/SUPAkidz_camps/ts4_volunteer_application_form_1.pdf