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Hospice South Volunteer Talent Application Form
We Thank You for your interest in Volunteering with Hospice South.
Your gift of time, skills and experience helps us to provide our palliative care services free of charge
to patients and their whānau in our community.
Please don’t hesitate to ask if you require assistance or clarification with any of the following questions.
Please complete the following:
Personal Details
Full Name:
Address:
Suburb and Postcode:
Date of Birth:
Contact Phone Number:
Email:
Emergency Contact Name and Number:
How did you hear about Volunteering for Hospice South?
Tell us about any previous volunteering, community involvement or life experiences that feel relevant.
What strengths, qualities, or skills would you like to share through volunteering?
What has drawn you or caused you to volunteer for Hospice, and what would make this a meaningful experience for you?
Where do you feel your interests and strengths could best contribute? (you are welcome to select
more than 1).
Some of these teams and work are at the hospice facility, fundraising and events in the
community and at our 6 shops located throughout Southland and Queenstown.
House Team
Kitchen assistants and cleaners help to
prepare IPU patient meals and maintain
a clean and comfortable environment.
Day Programme Team
Hosts patients who live in the
community at the hospice for a social
day out.
Living Legacies Biography Team
Assists people to record their life history
and experiences in biographies, or
with projects to pass on their skills or
knowledge.
Gardening Team
Help to Maintain our Beautiful Hospice Grounds
Hospice Shop Team
Help to turn second hand goods into first
class care.
Fundraising and Events Team
Assist with organising a variety of
community events such as the annual
Street Appeal.
Project Role
Use your skills for short term or one off projects at Hospice South.
Referee One
Name:
Contact Number:
Relationship:
Referee Two
Name:
Contact Number:
Relationship:
Privacy Statement and Consent to Police Check by Hospice South.
- The information that you supply will be used by Hospice South to consider your suitability for a volunteer position and will be held securely by Hospice South.
- No information that you have provided will be disclosed without your authorisation, except as required by Law.
- You have a right to access personal information held by Hospice South.
- I consent to the disclosure by the New Zealand Police any information they may have pursuant to myself, to Hospice South charitable Trust. I understand that any record of criminal convictions I might have will automatically be concealed if I meet the eligibility criteria stipulated in Section 7 of the Criminal Records ( Clean Slate ) Act 2004.
I declare that all information provided by me is true and correct.
Signature
Clear
Date:
If you have any Queries regarding this application, please contact our Volunteer Co-Ordinator.
Email: toni.eade@hospicesouth.org.nz
Cell: 027 254 7977
Submit
Please check the highlighted fields
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