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    Volunteer Form
    Please Enter Your Details Below
    MaleFemaleRather not say
    Date of Birth:

    are you on any medication?:

    YesNo

    Do you have ambulance cover:

    YesNo

    PARENTAL/GUARDIAN CONSENT

    I

    give permission for

    to participate in the Edmund Rice Centre WA youth programs. I understand that the programs will be mainly of an arts (e.g. media, performances), sports (e.g. training/games in various sports) or leadership (e.g. coaching) nature, and may include excursions and camps. I also understand that my child may be photographed or filmed while conducting activities on the youth programs and I give permission for these photographs and films to be used for informational material about the program and for the promotion of positive youth involvement in our community. I also understand and accept that my child may be transported in personal vehicles and that at any time I can request that this not take place. I will then be responsible for transporting/collecting my child is a bus is not available.


    I release the Edmund Rice Centre WA and partners from liability for any accident, illness or injury my child may sustain whilst involved in these activities. I understand that every effort will be made by the coordinator and other staff to contact me first and then the “emergency contact” named on the application form in the event of any illness or accident relating to my child. I hereby authorise that in the case of an emergency, the coordinator has my consent for my child to receive medical or surgical treatment if I am not able to be contacted. I confirm that the particulars on the application form and medical report are correct.
    I will arrange transport home:

    Transport homeMy child can walk home

    Would you like to volunteer for the program?

    YesNo

    Date: