Please complete this form:
First Name
Gender Male Female
Date of Birth 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 January February March April May June July August September October November December
Nationality
Home Number
Mobile No.
Fax Number
Home Address
PO Box
E-Mail
In case of emergency, notify
Name
Relation
Tel.
Provide TWO references we may contact who have known you for more than 1 year (excluding relatives)
email
Please check all that applies: Student Employed Retired Other
Current Work Place
Position held
School/Institution
Grade Level / Major
If you are volunteering for a school/program requirement, please complete the following:
School/Organisation
Hours required
Have you volunteered with KACCH before or had other volunteering experience? YES NO
Have you worked with children before? YES NO
Why do you want to volunteer with KACCH?
How did you learn of our organisation?
Of the following items, check those in which you have abilities or experience:
How would you like to volunteer? Play Decorating Paediatric Areas Fundraising Special Events Website Office Support
I am available to volunteer on the following day(s):
Preferred Hospital
Are you going on holiday soon? YES NO
If yes, Leaving date
Return date
Do you have any problems working...
With children up to 16 yrs Male/Female? YES NO
With children with special conditions (eg. Down’s Syndrome / Epilepsy / Cancer)? YES NO
When/where music is playing? YES NO
Are you presently on any medication? YES NO If so, please indicate reason: