Volunteer Registration Form
REGISTRATION FORM
A.
Personal Particulars
Name (as in passport and underline surname):
Name You Like To Be Known / Called:
Permanent Home Address:
E-Mail Address:
Home Number:
Mobile Number:
Nationality:
Facebook Account:
NRIC Number:
Passport Number:
Gender: Male / Female
Date of Birth:
Meal Restriction:
School / Employer:
Expiry Date:
Class / Occupation:
T-Shirt Size Preference (circle one):
Race:
XS / S / M / L / XL
Religion:
Any Previous Voluntary Work Or Community Involvement Activities? (Any Special Skills / Qualifications Including
Hobbies Or Sports?)
B.
In Case Of Emergency
Name Of Next-Of-Kin & Relationship:
C.
Home Number:
Mobile Number:
More information
1.
Why do you want to volunteer for CampVision?
2.
What Are You Looking To Achieve / Learn In CampVision?
3.
In what capacity do you wish to volunteer for CampVision? (Please refer to the Factsheet for more
information)
5
What Is Your Dream(s) Or Goal(s)?
Volunteer Registration Form
D.
MEDICAL DECLARATION
Age: ______
Height: ______
Weight: _____
Blood Group: ____
Do You Have Any Existing Medical Condition Or Allergies? If Yes, Please List Them All.
Please tick
NO
YES
Do you have / Require:
a. Chest Pains, High Blood Pressure Or Heart Problems Eg heart
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.
m.
n.
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Any Form of Disability?
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Any Other Medical Information To Take Note e.g. Specialist’s
Letter / Note (please attach); Pregnancy?
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murmur, extra heartbeat, mitral valve prolapse?
Asthma, Bronchitis, Tuberculosis, Sinusitis Or Other Lung
Problems?
Fits, Epilepsy, Fainting Spells, Migraine, Severe Head Injury?
Eye Problems Eg poor vision?
Ear Problems Eg hearing difficulty?
Nervous illness?
Diabetes / Thalassaemia Major / Anaemia?
Allergy to Medicine / Food / Others Eg sea water / insect bites?
Bone or Joints Injuries Eg fractures / dislocation?
A Carrier Status for Any Infectious Disease?
Medical Treatment within the Last Two Years?
Routine Medication?
E.
If YES, Please give further information
such as history, last known occurrence
restriction of movement etc.
DECLARATION
For applicant below 21 years old – please complete this section
MEDICAL DECLARATION
I declare that all the information provided above is true. My child / ward is not suffering from any acute ailments or diseases.
ACKNOWLEDGEMENT & CONSENT OF PARENT/GUARDIAN
I, the undersigned, allow my *child / ward to participate in all CampVision activities, including all the pre-camp activities and post-camp activities. I am
aware that my child’s / ward’s participation in CampVision involves certain amount of risks, therefore I acknowledge that l allow my child / ward
to participate in the camp voluntarily and with knowledge of these risks.
I understand that he / she will have to co-operate fully with CampVision and comply with all safety systems, guidelines and regulations as set
out. l shall therefore not hold Team CampVision and/or any of the event’s direct or indirect sponsors, responsible for any loss or damage of property
or any injury, illness or loss of life which may be sustained by my child / ward during the camp or arising from any cause or in connection with the
camp, where such damage to or loss of property or any injury or loss of life is not caused by the negligence or wilful act or omission of Team
CampVision and / or any of the event’s direct or indirect sponsors.
Parent’s Guardian’s
Name
:
NRIC Number
:
Signature
:
Date
:
For applicant above 21 years old – please complete this section
MEDICAL DECLARATION
I declare that all the information provided above is true. I am currently not suffering from any acute ailments or diseases.
UNDERTAKING
I hereby declare that the information given in this form is true to the best of my knowledge and that I have not wilfully suppressed any material fact
relevant to this application. I also understand that Team CampVision, the organiser of this event and/or any of the event’s direct or indirect sponsors
are not liable and disclaim any liability, including physical or otherwise that may occur in the duration of my participation in the event.
Your Name
:
Signature
:
Date
: