Greenwith Primary School - Department for Education

Given names *

As appears on your ID

Family name *

As appears on your ID

Are you a parent or guardian of a child at GPS? *

Childs name *

Preferred name for name badge

Date of birth *

Phone *

Email *

Address *

Address Line 1

City

State / Province / Region

Postal Code

Country

Gender

Emergency contact name *

Emergency contact phone *

Do you have any psychological or medical conditions that might affect your ability to volunteer? Or anything we need to know in case of an emergency? *

For example: diabetes, severe food allergy, asthma, epilepsy

If yes, please give details below *

Do you need any assistance because of a disability? *

If yes please give details below and discuss at your interview.

If yes, please give details below *

Your country of birth

Are you of Aboriginal and/or Torres Strait Islander origin?

Yes
No
Not stated

Do you speak any languages other than English?

Tell us about something you have done recently *

We would love to hear about any relevant experience (volunteering, employment or study details)

Name of organisation *

Tell us how you would like to contribute to your role as a volunteer *

Canteen
Classroom support
Fundraising
Sporting & SAPSASA
Resource Centre
Governing council and subcommittees
Excursions & Camps

Availability *

Mondays
Tuesdays
Wednesdays
Thursdays
Fridays

What days and times do you think you could volunteer?

To volunteer with us, you will need a working with children check. You understand that you will not be able to start volunteering until a clearance has been received *

Do you have a current working with children check? *

If you have a valid working with children check, please provide us with a copy including the SRN and issue date. If not, we can organise it for you using the details provided on this form.

We will contact these people to find out a bit more about you. It’s okay if it’s someone at our school or centre who already knows you. We just need at least one person’s details.

Referee name *

Referee email or phone *

How do you know this person? *

employer
volunteer coordinator
friend
relative
other (please specify):

To make sure we meet our commitment to child safety, we need this information and declaration from you.

If you have any questions about this declaration, please talk to the education or early childhood service leader.

Have you ever been investigated or found guilty of any criminal offence, including any traffic offences not resolved by expiation? *

Have you ever been dismissed or resigned from any employment or a volunteer role in response to or following allegations of improper conduct relating to children? *

Have you ever been the subject of allegations or an investigation or any other process relating to alleged misconduct by you as a volunteer or an employee? *

Have you ever been the subject of allegations of inappropriate conduct of a violent or sexual nature towards or in relation to anyone? *

Have you ever been refused a child-related employment screening or working with children check in South Australia or in another Australian jurisdiction? *

Are you a prohibited person, as identified in the Child Safety (Prohibited Persons) Act 2016? *

You understand that if the information in this application or declaration changes, it is your responsibility to advise the education and early childhood service leader as soon as possible. *

I confirm and declare that to the best of my knowledge I have truthfully answered all questions. I understand that if I provide any false or misleading information I cannot start or stay on as a volunteer *

Date *

Thank you for completing this form. The form will be sent via email to the volunteer coordinator. They might contact you and organise a time for an interview or a chat.

The information you provide will be treated sensitively and confidentiality according to the State Records Act 1997 and the Information Privacy Principles Instruction.

OFFICE USE ONLY: Site leader: Proof of ID sighted File created, stored securely and confidentially

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