Aunties and Uncles Volunteer Carer Application Form

Applicant One

Surname

Full Christian Name

Date of Birth

Place of Birth
(Town and Country)

Occupation

Place of Work/Study

Police Record

Yes

Please provide details of your police record (privately if desired)

Applicant Two

Surname

Full Christian Name

Date of Birth

Place of Birth
(Town and Country)

Occupation

Place of Work/Study

Police Record

Yes

Please provide details of your police record (privately if desired)

Address

Email Address

Home Phone

Work Phone

Mobile Phone

Please complete for all members of your household (include children and any adults who regularly stay overnight)

Name of Householder

Date of Birth

Male / Female

Male

Female

Relationship to you

Male

Female

Male

Female

Male

Female

Male

Female

Male

Female

Male

Female

Male

Female

Male

Female

Have you previously applied to be a foster carer or volunteer with any other agencies?

Yes

Please provide details and the result of the application

Previous experience volunteering with children:

Previous or Current Voluntary work, courses, etc:

What motivated you to contact Aunties and Uncles?

What other commitments do you currently have which impact on your time?

What do you hope to gain from being a volunteer carer?

How did you find out about Aunties and Uncles?

Are you willing to receive orientation and ongoing training?

Yes

Do you hold a current drivers licence?

Yes

Do you own a motor vehicle?

Yes

What level of motor vehicle insurance do you have?

Do you or other people in your household smoke at home?

Yes

Referees

Two people to whom we can refer. The two referees should be from different families, not related to you and have known you at least 2 years.

Name

Address

Home Phone

Work Phone

Name

Address

Home Phone

Work Phone

Emergency Contact Person

Name

Address

Home Phone

Work Phone

I confirm to the best of my knowledge that the above information is correct and I am prepared to make a commitment to have the child spend one weekend per month with me, for a minimum of one year.