MCTimebank Membership Form -adult

Member Application Form

Adult
Welcome - we are thrilled you are interested in joining the Mid Canterbury TimeBank!

The joining process is as follows:
- fill out this member application form
- we'll get in touch with upcoming Starter Session dates
- you attend a Starter Session
- pay your $5 or $10 joining fee
- show us your photo id
- we'll complete your referee checks
Once all the above is done, you will be a Mid Canterbury TimeBank member!

So let's get started...
Full Name*

First NameLast Name
Gender

FemaleMaleOther
Date of Birth*

DayMonthYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Number

Area CodePhone Number
Mobile Number

Area CodePhone Number
E-mail*
References: Please provide two character referees who are not relatives of yours. If you are offering to care for children and/or vulnerable people, please ensure that one of your referees can endorse your competence in this field. (e.g., the parent of a child you have looked after).
Ref 1 Name *
First and Last Name
Ref 1 Phone Number*

Area CodePhone Number
Ref 1 Email*
example@example.com
Ref 2 Name *
First and Last Name
Ref 2 Phone Number*

Area CodePhone Number
Ref 2 Email*
example@example.com
Language(s) I speak
What community groups are you involved in (if any)?
What iwi connections do you have (if any)?
Do you have any health problems or disabilities you’d like us to know about?
Are you interested in being involved in group projects or working bees?

YesNoMaybe
Would you be happy to help other members with their trades?

Love toNo thanksMaybe
Would you like to help the Timebank run? Or help with 'Keep Learning Mid Canterbury' (our Trust's other initiative)? You'll earn time credits for your time volunteering.

No thanksMaybeLove to
If you're interested in volunteering, what roles would you like to hear more about?

Admin assistanceLayout/ DesignMember supportEventsSocial media contentKeep Learning Mid CanterburyFundraisingGovernanceDigital Storytelling
Email
example@example.com
If you're interested in volunteering, what roles would you like to hear more about?

Admin assistanceMember supportSocial media contentFundraisingDigital StorytellingLayout/ DesignEventsKeep Learning Mid CanterburyGovernance
How did you hear about the Timebank? (choose all that apply) *

FacebookNewspaperFriendRadioKeep Learning EventHealth professional/ Community workerOther
Is it ok for us to use photos that include you at TimeBank events or exchanges in our members-only newsletter, on our Facebook page or in TimeBank promotional materials?

YesNo
Mid Canterbury TimeBank works to create connections and to facilitate the exchange of skills and services to a cross section of our community, including vulnerable people. It seeks to ensure that potential members have maintained personal standards of conduct and behaviour that do not compromise the integrity of the TimeBank or put other TimeBank Members at risk. The questions below assist to minimise such possibilities. Please note that if you answer yes to any of these questions, it does not necessarily exclude you from being a member of the TimeBank. (Request our membership policy for details if interested.)
Have you had a criminal conviction? *

YesNo
Please detail
Have you received police diversion for an offence?*

YesNo
Please detail
Have you been convicted of a driving offence in the last seven years, which resulted in temporary or permanent loss of licence, or imprisonment? (Those with such a record will still be eligible to join the TimeBank but will not be able to offer driving services.)*

YesNo
Are you awaiting sentencing/currently have charges pending? *

YesNo
Please detail
Please note: you may be required to consent to disclosure of any information held about you by the New Zealand / Australian Police or Ministry of Justice. You are not required to disclose convictions covered by the clean slate act unless you intend to provide support to Vulnerable Children. You can find out more information about the Clean Slate Act here: https://www.justice.govt.nz/criminal-records/clean-slate/ .

Information provided will be treated in the strictest confidence and past criminal convictions will not necessarily prevent you from becoming a member of the Mid Canterbury TimeBank.
Are you willing to have a police vet/ criminal history check?*

YesNo
Mid Canterbury TimeBank Membership Agreement
- I understand that the acceptance of my application to join Mid Canterbury TimeBank will depend on the outcome of the reference checks.
- I authorise Mid Canterbury TimeBank to release relevant information concerning my abilities and fitness to provide services to those members who may seek to use them.
- I understand that as TimeBank members we offer and provide services to each other. We carry these out to the best of our abilities and do not guarantee our work. I accept that Mid Canterbury TimeBank will not assume liability for claims, damages, or any other consequences that may arise from activity related to exchanges between members.
- In arranging to receive a service, I undertake to use the same precautions I would in engaging the services of any person, especially for the care of vulnerable people, and driving.
- In receiving a service, I undertake to do my best to ensure the health and safety of the member providing that service.
- When providing a service, I understand that it is my responsibility not to attempt any work beyond my fitness and competence. I also understand that I am able to decline requests.
- I understand that the email address I have registered on the Mid Canterbury TimeBank website is for receiving messages from other members and the coordinator.
- I pledge not to disclose information available to members, including that on the Mid Canterbury TimeBank website, to non-members.
- I pledge to participate with good intent in the Mid Canterbury TimeBank community, and to treat my fellow members with courtesy, kindness and discretion.
- I pledge to follow the health and safety policy requirements for the Mid Canterbury Timebank. As a member of the Timebank I will take responsibility to; keep myself safe, not cause harm to others and follow any instructions given to me by Connecting Mid Canterbury Board or the Mid Canterbury TimeBank coordinator.
I agree with the above Member agreement.
Code of Conduct
- Prior to accepting a service, I will respectfully ascertain the competence of the member providing it to deliver the service to my satisfaction.
- I will discuss proposed transactions beforehand with my exchange partner to clarify and agree on details, particularly the reimbursement of any expenses.
- I will respect my exchange partner's privacy, confidentiality, their home, and their property.
- I will respond promptly to all offers and requests made to me.
- I will keep my website profile and trading account up to date.
- I will inform the coordinator of any problems or concerns that I consider may affect the positive operation of the TimeBank or the safety of members.
I agree to abide by this Code of Conduct.
Date

DayMonthYear
What days/times are generally possible for you to attend Starter Sessions? (e.g. daytime/ evenings/ specific days?)*
Should be Empty:

Member Application Form

Mid Canterbury TimeBank Membership Agreement