To apply to become a volunteer, please fill in this form:

Name

Phone

Address

Drivers Licence Number

Type

Expiry Date

Dr Name

Dr Phone Number

Emergency Contact Name

Relationship

Emergency Contact Phone

Have you ever worked as a volunteer before? Is so please give details

Please provide details about any health or other matters, including allergies or medications, that may be relevant to your ability to undertake volunteer work assigned:

Please provide details of any certificates, experience or skills that may be applicable for volunteering with Central Highlands Rural Health

I hereby declare that i have not been charged with or convicted of any offence which would disqualify me from submitting this application. I consent to Central Highlands Rural Health making all enquires it deems necessary including consent for a National Police records Check. If my application is acepted, i will abide by the policies and guidelines laid down by Central Highlands Rural Health

To apply to become a volunteer, please fill in this form:

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