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Hospice Southland Volunteer Application Form
We Thank You for your interest in Volunteering with Hospice Southland.
As a Volunteer, your gift of time, skills and experience helps us to provide our Palliative Care Services free of charge to our Southland and Wakatipu Basin Communities.
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 Southland?
What experience do you have in Volunteer Work??
What personal qualities and skills can you bring to a Volunteering Role with Hospice Southland?
Please indicate the area/s you are interested in Volunteering with.
House Team
Kitchen Assistants and Cleaners help to prepare patient meals and maintain a comfortable Environment.
Day Programme Team
Hosts Community Patients at the Hospice for a socail day out.
Living Legacies Biography Team
Assists Patients to record their life history and experiences by creating a Living Legacies Biography or Letter.
Gardening Team
Help to Maintain our Beautiful Hospice Grounds
Hospice Shop Team
Help out in our Shops where we turn Second Hand Goods into First Class Care!
Fundraising and Events Team
Assist with helping out with our Variety of Community Events.
Referee One
Name:
Contact Number:
Relationship:
Referee Two
Name:
Contact Number:
Relationship:
Privacy Statement and Consent to Police Check by Hospice Southland
- The information that you supply will be used by Hospice Southland to consider your suitability for a volunteer position and will be held securely by Hospice Southland.
- 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 Southland.
- I consent to the disclosure by the New Zealand Police any information they may have pursuant to myself, to Hospice Southland 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@hospicesouthland.org.nz
Cell: 027 254 7977
Submit
Please check the highlighted fields
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