Required fields are marked with an asterisk (*).
Personal details I am over the age of 18 * Yes First name * Last name * Pronouns Preferred name Telephone * Suburb Date of Birth * Day 12345678910111213141516171819202122232425262728293031 Month JanFebMarAprMayJuneJulyAugSeptOctNovDec Year 1900190119021903190419051906190719081909191019111912191319141915191619171918191919201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026 Email address * Additional information Can you speak/write in a language other than English? If so, please provide details 100 words remaining Is there anything that could limit the type of volunteering activities you can do, or for which you may require extra support? If yes, please provide details 150 words remaining Please tick your areas of interest * Emergency Department Intensive Care Unit Wayfinding Service - Canberra Hospital Wayfinding Service - University of Canberra Hospital Canberra Region Cancer Centre: Transport Driver Canberra Region Cancer Centre: Trolley Service Canberra Region Cancer Centre: Breast Screen Paediatric Support Canberra Community Dialysis Centre (CCDC) Donate Life Justice of the Peace Service P.A.R.T.Y (Prevent Alcohol and Risk-Related Trauma in Youth) Speech Pathology (Talkback) Advanced Care Planning Canberra Hospitals Foundation: Gift Shop Canberra Hospitals Foundation: BBQ Heart Support Australia What is your availability for volunteering Day Time Time Time Monday Morning Afternoon Evening Tuesday Morning Afternoon Evening Wednesday Morning Afternoon Evening Thursday Morning Afternoon Evening Friday Morning Afternoon Evening Saturday Morning Afternoon Evening Sunday Morning Afternoon Evening Declaration I understand that I will be required to undergo a vaccination screening, a national police check and hold a Working With Vulnerable People Card before volunteering with CHS. I hereby declare that the information provided is correct and true.
