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

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

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REFEREESIt is preferable for you to list work related referees or previous volunteer Co-ordinatorsName Title CompanyRelationship Home Telephone Mobile NumberName Title CompanyRelationship Home Telephone Mobile NumberMEDICALIs there anything that would prevent you from performing certain types of work?(please circle) YES NOIf yes, please explain:____________________________________________________________________________________________________________________________________________________I have provided accurate information to the best of my knowledge. The facts outlined in thisapplication are true and complete. I authorise <strong>Novita</strong> to undertake referee checks to supportmy application.I confirm that I have read the “<strong>Volunteer</strong> Handbook” and agree to abide by the <strong>Volunteer</strong>Policies and Procedures on pages 15 – 19 and the Code of Conduct overleaf.I agree to undertake voluntary services within <strong>Novita</strong> Children’s Services and I acknowledgeand agree that my performance will be monitored, I will not receive any monetary reward formy services and I agree to undertake a Police Clearance.I understand and agree that any deliberate omission or misrepresentation of the facts in myapplication will be justification to refuse or terminate my association with <strong>Novita</strong> as avolunteer.Name Signature DateName Signature DateParent Guardian (if under 18 years)Author:TeenZone Page 4 of 5Date Created: 15/07/2010 Last Review Date: 15/07/2010Last Modified Date: 16/07/2010© <strong>Novita</strong> Children’s Services <strong>Novita</strong> website- Terms & Conditions of Use

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