THE SHACK COMMUNITY CENTRE & NU-ROAD WELFARE INC.

A PART OF THE SOLUTION

First name

Last name

Phone

Birthday

Day

Month

Year

Address

Postcode

Church you attend (if applicable):

Number of your Pastoral Care Person (If applicable):

Please list any trade or professional qualifications you may hold:

Been referred to by or spoken with The Shack Management. This is required to continue this form.

Blue Card and Identity Card

Please provide a current and up-to-date Blue Card (this is a requirement by the government to volunteer).

Please provide either a Drivers License or 18+ card to provide proof of identity.

Have you ever been charged with/or convicted of a criminal offence? If yes please provide brief details below: