KABC volunteer registration form
Name
*
First name
Last name
Gender
Male
Female
I'd rather not say
Date of birth
*
-
Day
-
Month
Year
Date
Are you over 16 years of age?
*
Yes
No - if the answer is no, please state the name of the parent or guardian who will accompany you while volunteering.
Name of parent or guardian
Your address
*
Street Address
Street Address Line 2
Suburb/Town
State
Post code
Local Government Area (LGA)
*
Phone number
*
Email
*
example@example.com
Occupation
Let us know if you can help with a specific skill set.
Emergency contact person
*
Name the person we call if you need assistance or have a medical issue while volunteering.
Emergency contact phone number
*
Only used in the case of emergency.
Photo permission - at events we take photos of people and outcomes for use on website and social media. If you do not wish to be involved in these opportunities please tick this box and alert people at the event of your wishes.
*
I give permission to appear in photographs and understand they may be used for promotional purposes.
I do not give consent to be included in photos at events.
Your health
*
I am fit and healthy.
I have a medical condition - please give details below.
Medical condition
Do you have any medical conditions, allergies, disabilities, past or present injuries that may affect your participation (eg back injury)? Please describe any medical condition that may affect your participation.
Declaration
*
Yes, I declare that I am in good mental and physical fitness and know of no physical disorder which should keep me from participating in this activity.
Yes, I declare I do not have a criminal record that includes child-related offences.
Declaration
*
Yes, I declare that I am in good mental and physical fitness and know of no physical disorder which should keep me from participating in this activity.
Yes, I declare I do not have a criminal record that includes child-related offences.
Name of event
*
Please Select
General volunteer
Adopt-a-Spot/Clean up
Coastal Waste Warriors
Port Coogee Community Association
Eco Surf Australia
WABCU
Please select which event you are volunteering for. If there is no specific event please select 'General volunteer'.
Adopt-a-spot/Clean-up Area/ WA Beach Clean up site
If you are registering for an Adopt-a-Spot or a Clean up or WA Beach Clean up site please let us know where it is.
Do you have a current Working With Children Check?
I have a current WWCC
I don't have a current WWCC
Enter your WWCC number
Submit
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