Agency Registration Form

Organisation Profile

Organisation Name*

Website

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Volunteer Manager Name*

First Last

Phone*

Email*

Other Contact Name

First Last

Phone

Email

Status of Agency*

Incorporated
Not Incorporated
Local Government
Other

Please provide a brief description of your organisation's services and mission. "Who you are and what you do" The details you provide will assist us to promote your organisation.*

Insurance Details

Your organisation is required to provide copies of Certificates of Currency for Public Liability Insurance and Volunteer Personal Accident Insurance at the time of registering. Please note that we DO NOT conduct reference checks, police checks or working with children checks and we strongly urge organisations to undertake these where necessary. As always, the decision to accept a volunteer rests with you.

Does your organisation hold insurance coverage for Public Liability AND Personal Accident Insurance for Volunteers?*

Yes
No

Public Liability Insurance Policy Number*

Expiry Date*

Personal Accident Insurance Policy Number*

Expiry Date*

Volunteer Position Description

Please provide us with details of your available volunteer position below

Position Title*

Location*

Position description*

Include a description of the benefits for the volunteer and the organisation

Requirements

Include any qualifications, experience and/or skills required to complete this role

Minimum age of prospective volunteers*

Taking into account your Insurance coverage, tasks required, clients etc

Maximum age of prospective volunteers*

Number of volunteers required*

Duration*

Long term
Short term
One off event

Working environment*

Alone
With others
Alone and with others

Availability

Monday

Morning
Afternoon
Evening

Tuesday

Morning
Afternoon
Evening

Wednesday

Morning
Afternoon
Evening

Thursday

Morning
Afternoon
Evening

Friday

Morning
Afternoon
Evening

Saturday

Morning
Afternoon
Evening

Sunday

Morning
Afternoon
Evening

Licences and Checks Required

Please provide details on what checks are required from prospective volunteers to enable them to apply for this role

Working with Children Check

Yes
No

National Police Check

Yes
No

Drivers Licence

Yes
No

Checks are payable by

Volunteer
Organisation

Access to Volunteering

CVS supports universal access to volunteering, Please consider the requirements for this role and assess the suitability of potential volunteers

A volunteer from a non-English speaking background (C.A.L.D)

Yes
No

A Centrelink client who is required to complete volunteering hours as part of their approved activity

Yes
No

A volunteer with limited physical ability

Yes
No

A volunteer with an intellectual disability

Yes
No

Student Volunteers aged 13 - 17 years

Yes
No

Adults available for a short time (Uni and TAFE students, travelling)

Yes
No

Listed on the internet (recommended)

Yes
No

Group/corporate volunteers

Yes
No

Anything else you'd like to add to assist us in recruiting and referring the right volunteers for this position?

Authorisation

I authorise Centacare Volunteer Service to promote my organisation and available volunteers position/s via their database and subsequent volunteer search engines in order to recruit and refer suitable volunteers to my organisation. I also give consent to my details being entered into their database to be used for volunteering recruitment purposes.

I agree*

Yes
No

Please complete this form to apply for membership. The form asks for the following information: