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Title Mr Mrs Ms Miss
First Name *
Surname *
Street Address *
Suburb *
Post Code *
State - Select State - Australian Capital Territory New South Wales Northern Territory Queensland South Australia Tasmania Victoria Western Australia *
Gender Male Female
Date of Birth (dd/mm/yyyy) *
Home *
Work
Mobile *
Email Address *
This person will be contacted in the case of illness or injury whilevolunteering at Animal Aid
Relationship *
Please provide details where possible if you select yes to any of the following
Do you have a current Work Cover claim? Yes No
Specify
Do you have any allergies? Yes No
Do you have any relevant medical conditions? Yes No
Do you have any disabilities? Yes No
Is your tetanus up to date? Yes No
If you specify "yes" to any options below, proof of experience or certification is required
Veterinary Care Yes No
List Experience/Certifications *
Wildlife Handling Yes No
Endorsed Licensed Driver Yes No
Animal Handling Experience Yes No
Emergency Services Yes No
Forklift License Yes No
First Aid Yes No
Qualification Level - Select Qualification Level - Basic First Aid Senior First Aid Occupational First Aid Remote First Aid
In the event of a Natural Disaster, I can help with: Donor Coordination Customer Service Data Entry Manual Labour General Maintenance Traffic Control Kennel/Pen Cleaning Animal Care Assisting with Incoming/Outgoing animals Delivery/Pick-Up Driver Staff/Volunteer Support other
Explain *
In the event of a Natural Disaster, I can provide: Temporary Agistment Offsite Storage Delivery Vehicle/Trailer Horse Float Cages or Crates Temporary Foster Care other
Which animals can you care for: Cats Dogs Pocket Pets (rabbits, guinea pigs etc) Birds Poultry Fish Reptiles *
I agree to all the terms stated above *
Title
First Name
Surname
Gender
D.O.B.
Street Address
Suburb
State
Post Code
Home Phone No.
Mobile No.
Work Phone No.
Email Address
Are you on Work Cover?
Details
Allergies?
Relevant medical conditions?
Any disabilities?
Up to date Tetanus?
Veterinary Care Experience
Wildlife Handling Experience
Endorsed Licensed Driver
Animal Handling Experience
Emergency Services Experience
Forklift License
First Aid Qualification Qualification Level
In the event of a natural disaster
I can help with
Other Explanation
I can provide
Providing Foster care for
