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SPARK (St Vincent de Paul Society Assisting Refugee Kids) Providing refugee children and their families with community support through schools
Personal Details First Name:
Last Name:
Address: Suburb:
Postcode:
Home Telephone:
Work / Mobile:
Email: Date of Birth:
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Gender: F / M
Emergency Contacts – COMPULSORY (Please note at least one contact must be within Australia) Name:
Name:
Home Phone:
Home Phone:
Mobile:
Mobile:
Please note below any medical conditions of which we should be aware of and where applicable, information about emergency treatment
Referees for a character reference - COMPULSORY Please provide the names of two referees, not related to yourself, who could vouch for your ability in working with young people. Please inform your referees that they may be contacted as part of the screening process. (Please note: referees must be within Australia) Referee 1:
Phone:
How do you know them?: How long have you known this person? Referee 2:
Phone:
How do you know them?: How long have you known this person? 1
Why are you interested in volunteering with SPARK?
What are your expectations of volunteering with SPARK?
How did you hear about SPARK?
Have you had experience as a Volunteer?
Yes/No
If yes, please give details of experience and responsibilities.
Have you had any experience working with refugees?
Yes/No
If yes, please give details of experience and responsibilities.
Please let us know what other languages you speak fluently (if any):
Please detail any other skills you have that would benefit the activity?
Do you have a current Senior First Aid Certificate or other first aid qualification? Yes/No If yes, and if you are interested in being a SPARK First Aid Officer, please detail qualification and send us a copy. More details on the role will be forwarded to you. Are you available to volunteer one afternoon a week (Mondays – Thursdays) from 3pm – 4.30pm? Yes / No
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Volunteer’s Statement I, _________________________________, am volunteering to participate in the SPARK program. I have read the attached information detailing the activity. By signing this form I agree to the following: •
I agree to work in cooperation with other staff, volunteers and participants in the SPARK program
•
I understand that during the SPARK program I am responsible to the SPARK Volunteer Leader in the school at which I am volunteering
•
I understand I may work one to one with children in the SPARK program or with multiple children in small groups
•
I understand that my volunteer role is subject to a three month trial period
•
I understand that as part of the screening process my referees will be contacted and I will need to sign a Prohibited Employment Declaration Form
•
I agree to act in accordance with the code of conduct, mission and vision of the St Vincent de Paul Society
•
I understand that the St Vincent de Paul Society does not accept responsibility for lost, damaged or stolen property belonging to any individual
•
I understand that I will be responsible for all travel expenses incurred to and from the SPARK venue
•
I commit to completing an exit survey when I choose to exit the SPARK program
•
I commit to attending every SPARK session for the period I am engaged with SPARK
Name (please print): Signature:
Date:
*(The document can be signed at the training day) If under 18, a parent/guardian is required to read and sign below also. Parent/Guardian Name (please print): __________________________________ Signature: _____________________________ Date: ____________________ Please return this form to: SPARK Volunteer Recruitment and Support Officer spark@vinnies.org.au St Vincent de Paul Society PO Box 5 PETERSHAM NSW 2049 Tel: 9568 0280 Fax: 8622 0323 This form is intended to be used to assist the Society in the case of any emergency, medical or otherwise involving a participant on Vincentian activities. The information collected will be held in a secure place and will be made available to Society staff and medical or paramedical staff in the case of an accident or emergency. The information contained in the form is personal information and it will be stored, used and disclosed in accordance with the requirements of the Privacy Amendment (Private Sector) Act 2000.
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