VOLUNTEER ENROLLMENT FORM

Please complete this form by typing or using CAPITAL letters

Name:

Address:

Residential (Physical location) :

Postal:

Occupation & Place of Work:

Telephone:

Home:

Work:

Cell:

Email:

NGO Membership:

Are you  a member of a service club/organization or other NGO? 5Yes       5No (Please tick as appropriate)

Details of NGO (if applicable) e.g. Name, your position etc:

SKILLS

What skills do you possess that may assist in Disaster Management activities.

Volunteer Area: (What is your area of interest)

1.                    Damage Analysis and Needs Assessment (DANA)

2.                    Relief Distribution

3.                    Shelter Management

4.                    Other (Please see attached form)

Brief Description of Volunteer background (if applicable)

1.        Are you the holder of a valid driver’s license?          5Yes       5No (Please tick as appropriate)

2.        Are you the holder of a heavy goods vehicle license?               5Yes       5No

3.        Do you have access to a vehicle that could be used in the performance of your volunteer duties?                                                                5Yes       5No

4.        Do you have health insurance?                             5Yes       5No

5.        Do you have life insurance?                                 5Yes       5No

6.        Are you willing to participate in disaster-related training? 5Yes                5No

I certify that the information contained in this form is to my knowledge accurate and true.  I agree to abide by the rules and regulations of the DDM Volunteer Programme.

Signature:________________________________             Date:_____