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Bellarine Salvos Outreach and Emergency Services- Adult Volunteer Registration Form

Bellarine Salvos Outreach and Emergency Services- Adult Volunteer Registration Form


Medical and Personal Information Form

Personal Contact Details

Safety and Care Details

Information on Relevant Conditions

Medical Information

Particular Activities

In attending the program, you consent to participation in a range of physical activities including walking in the dark with torches. If potentially risky activities of a specific nature are included, the Team Leader will inform you of these.

Your Agreement With The Organisation

I am aware, in signing this document regarding my participation in this program, that certain elements of the program could be physically and emotionally demanding. Furthermore, I understand that certain inherent risks and dangers exist in the activities in which I will be participating. I acknowledge that while the organisation and its leaders will make every reasonable effort to minimise exposure to known risks, all hazards and dangers associated with these activities cannot be foreseen or may be beyond the control of the organisation, its leaders and staff.  In the event of any emergency where my nominated contact people are unavailable:

  1. I authorise the leaders to obtain medical advice and/or assistance which they deem necessary.
  2. I further authorise qualified practitioners to administer anaesthetic if required.
  3. I accept all operation, blood transfusion and/or anaesthetic risks involved in the event that such procedures are deemed necessary.
  4. I accept the responsibility for payment and agree to pay medical, transport and any other related expenses.
  5. I confirm that the information contained in this application is true and correct.
  6. I agree to inform the leader of any change to these details.

Integrity Check Information

PLEASE TICK - It is The Salvation Army policy that all volunteers must consent to undergo an integrity check. 

If you already have a current Working with Children Check please upload a copy below.


It is now Salvation Army Policy to make sure all volunteers have at least two character references before becoming a volunteer.

Reference 1

Reference 2

Thank you for completing the above details. The details on this form will be entered into our secure online Volunteer Management System. For details of how your information is secured please refer to The Salvation Army’s Privacy Notice included in the Volunteer Agreement Form or via our website,

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