Mrs, Ms, Miss, Mr

Your best phone number for contact

Please specify type, date obtained, and learning institution

Please give details of 2 references to support your application:

Please provide details for an emergency contact

It is necessary for us to maintain a brief medical history of our volunteers

Costs for any required ambulance are the responsibility of the volunteer

I certify that to the best of my knowledge, the above details are true and complete. I understand and agree to abide by the policies and procedures of BWA. I agree to follow direction given in relation to the safe performance of tasks and to undertake tasks in a way that does not endanger my own safety or the safety of others. Whilst acting as a Volunteer, I understand that I am covered by BWA’s insurance policy, subject to the terms of the policy, (as detailed in the BWA Policy and Procedure Manual). Whilst acting as a Volunteer I understand that I must follow reasonable direction in regard to Occupational Health and Safety as set down under the Work, Health and Safety Act and BWA policy. I understand that it is my obligation and responsibility to Blind Welfare, its Members and staff, not to disclose any confidential information obtained in the course of duty. I understand that BWA reserves the right to terminate my services as a Volunteer through appropriate process. I understand that BWA will conduct two Screenings through the Department of Community and Social Inclusion (DCSI), covering Aged Care Employment and Disability Services Employment as part of this application.Failure to disclose any relevant information (including medical conditions), which may impact on your role as a Volunteer may result in the termination of your Volunteer services with BWA. I give permission for my photograph to be used for publications to promote BWA eg our website.