Volunteer/Work Experience Registration Form - Novita Children's ...

7. PERSONAL DETAILS__________________________________________________________________________Surname Given Name Middle Name__________________________________________________________________________Address Postcode Date of Birth__________________________________________________________________________Home TelephoneMobile NumberEmail address _______________________________________________________Emergency Contact Details:__________________________________________________________________________NameTelephone Number8. Do you have a National Police Clearance? Yes NoIf yes. please provide proof.If no. are you prepared to get one (no cost involved) ? Yes No9. Have you ever been convicted of any crime (other than routine vehicleviolations)? Yes NoIf YES, please explain:10. Do you have a current Mandated Notification Certificate? Yes NoIf yes please provide proof.11. TeenZone runs at two sites:TeenZone RPC c/o 171 Days Road Regency ParkTeenZone Hamilton c/o 815 Marion Road Mitchell ParkAre you available for either site? Yes noWhich site would you prefer : Regency Park Centre or Hamilton (please circle)12. When would you prefer to volunteer at TeenZone?After School Care 3.15pm =6pm at Regency Park : Mon, Wed, ThursVacation Care 8am-6pm school holidays Regency Park/HamiltonPlease write down the dates and times you wish to attend.____________________________________________________________________________________________________________________________________________________Author:TeenZone Page 2 of 5Date Created: 15/07/2010 Last Review Date: 15/07/2010Last Modified Date: 16/07/2010© Novita Children’s Services Novita website- Terms & Conditions of Use