CampEVOLVE Student Volunteer Information Form 2022

CampEVOLVE Student Information Form

Please complete this application for volunteering at CampEvolve 2022
CampEVOLVE dates: October 4th- 7th 2022
Location: Woodhouse Activity Centre (Spring Gully Road, Piccadilly)

This form is expected to take approximately 20 minutes.
It is IMPORTANT that you do not close your web browser while you are completing this form, as the details will not save and you will need to re-submit.

You will receive a confirmation of your submitted form by reply email, if you have completed the form successfully. If you do not receive a receipt of your form submission by email, please re-submit your form.
Student Name:*

First NameLast Name
Preferred name:*
Gender:*

MaleFemaleOther
Date of Birth

DayMonthYear
Phone:*
Email:*
example@gmail.com
Compulsory - Please upload your Working With Children Clearance*

Cancelof
Compulsory - Please upload your NDIS Worker Screening, previously known as the DHS Disability worker screening if obtained before the 1st of February 2021*

Cancelof
Compulsory - Please upload a copy of your Photographic ID*

e.g Drivers License
Cancelof
Degree Information (University & Year Level):*
Employment History:*
Company, Length of Employment & Role Description
T-Shirt Size?*
Emergency Details
Next of Kin:*
Name of emergency contact
Next of Kin Contact Number:*
Contact number of emergency contact
Do you have any allergies?*

YesNo
If Yes, detail:
e.g. Shellfish, Nuts etc
Do you have any dietary requirements?*

YesNo
If Yes, detail:
e.g Lactose Intolerant
Do you have any medical conditions*

YesNo
If Yes, detail:
e.g Asthma, migraines etc
Are you willing and able to sleep overnight at Woodside Activity Centre should you be required to do so as a part of your CampEVOLVE commitment?*

YesNo
If No, detail:
Please outline 3 reasons why you would like to attend CampEVOLVE 2022:
What do you hope to gain from this experience?
What camp group are you most interested in working with during CampEVOLVE:
Preference One*
Preference Two*
Preference Three*
What experience have you had working with children? Working with Groups?
Are there any concerns/injuries that would limit your ability to participate at camp?
CONSENT TO VIDEO/PHOTO

During the preparation and duration of CampEVOLVE a large part of the communication with our families is done via the Seesaw (communication app). We use this app to send families messages, information and reminders. We also use this app to post regular daily photos of the children and share end of day summaries for each group.

In agreeing to attend CampEVOLVE you acknowledge and agree that your photo may be taken and shared with a child’s family as it is very hard for us to exclude some team members from photos throughout the day.

We also like to share some photos of the experience of CampEVOLVE with our wider OTFC community via our social media pages, website footage, youtube channel, educational material and group trainings. We understand that you may not wish for your image to be shared on these pages and that is ok.

Please complete the below statement:
I consent to being photographed &/or filmed during the CampEVOLVE experience and this footage to be used for future CampEVOLVE distribution and education material, OTFC website, group emails and social media.*

YesNo
MEDICAL FORM - AUTHORISATION & RELEASE

I understand that Occupational Therapy For Children and its Therapists will take reasonable care for the welfare and the safety of those attending CampEVOLVE but they are not responsible for any sickness or accident otherwise occurring.

I have detailed herein and on attached pages any disabilities or susceptibilities affecting myself that may place me at greater risk than normal.

I authorise OTFC to obtain medical assistance and ambulance transportation in the event of an illness or injury as they think necessary and authorise medical practitioners to administer anaesthetic, blood transfusions or any other procedure deemed necessary.

I also agree to pay all the cost of any expenses incurred as a result of such medical assistance and ambulance transportation.
I agree to the above details in the Medical Form - Authorisation & Release*

YesNo
Medicare Number:*
Do you have Ambulance Cover?*

YesNo
Do you have Private Health Cover?*

YesNo
If yes, what is the fund name?:
e.g Bupa, Health Partners
Who is your GP/Doctor?:*
e.g Dr Smith
At which practice is your GP/Doctor located?:
e.g Norwood Medical Centre
GP/Doctor Phone Contact?:
e.g (08) 0000 0000
It is not necessary to provide a full medical history.
OTFC CampEVOLVE staff only need to know information relevant to your attendance, learning and well-being in this particular setting.
Do you suffer from heart problems? Blood pressure concerns?*

YesNo
If yes, please detail:
Have you been hospitalised in the past year?*

YesNo
If yes, please detail:
Have you suffered significant physical injuries in the past or required surgery?*

YesNo
Commitment to OTFC CampEVOLVE 2022
The successful delivery of CampEVOLVE requires over 12 months of planning, recruitment of staff, purchase of specific camp materials, increased therapy equipment and a lot of time.

Participation in CampEVOLVE requires a firm commitment from you that once you have been accepted into CampEVOLVE as a student you will honour that.

You will need to agree to the following statements:
Deposit Payment
Please tick which option you have chosen to pay your deposit:*

I am paying my deposit via EFT Transfer to the 'Bank Details' listed belowI wish to pay by Credit Card, please see credit card details below
Details of OTFC Bank Account:

Name: OTFC Pty Ltd
BSB: 065 - 000
Bank: CBA
Account:1230 2226
Reference: Please quote child's SURNAME & CAMP in the reference line and email remittance to grace@otfc.com.au
Payment notes:
Credit Card Details

You may call OTFC (8410 4522) and add your credit card details to our secure file over the phone if you prefer.
Name on Card:
Credit Card Type
Credit Card Number
Credit Card Expiry Date
CCV No.
Amount:
Please tick which option you have chosen to pay your deposit:*

I give permission for all my camp payments to come off the above credit card on their due dates 24th June and 15th JulyI DO NOT give permission for all camp payments to come off the above credit card. I understand that the only payment to come of the credit card will be the deposit of $120. I am responsible for contacting OTFC to make the remaining payments
Name of person completing this form:*

First NameLast Name
Contact email address:*
example@example.com
Signature*

Clear
Should be Empty:

CampEVOLVE Student Information Form

Emergency Details

Commitment to OTFC CampEVOLVE 2022

Deposit Payment

Credit Card Details