Regional Registration Form Your Details Question Title * 1. Personal Details Name Date of Birth Address Suburb Postal Code Email Address Phone Number Question Title * 2. Do you have your own transport? Yes No Question Title * 3. Do you check your emails regularly? Yes No Question Title * 4. We would like to keep you informed on what is happening at Animal Aid. Do you authorise Animal Aid to send you information via email or post? Yes No thank you Question Title * 5. How did you find out about Animal Aid? Question Title * 6. So that we can place you in a suitable department please tick any of the following that apply to yourself and explain in further detail in the comments box below. Learning Disabilities Mental Health issues Pre existing injuries, physical disability or restrictions Allergies Medical Condtions Fear or unsure of medium to large dog breeds Details Question Title * 7. Emergency Contact 1 Name Relationship Phone Number Question Title * 8. Emergency Contact 2 Name Relationship Phone Number Question Title * 9. Please select your location preference Bairnsdale Shelter Sale / Fulham Shelter Bairnsdale Op Shop Lakes Entrance Op Shop Foster Carer Events Question Title * 10. Please select the days and times you are available to volunteer. Available Times Monday AM Shift - 9am - 1pm PM Shift 1pm - 5pm Full day Shift 9am - 5pm Monday Available Times menu Tuesday AM Shift - 9am - 1pm PM Shift 1pm - 5pm Full day Shift 9am - 5pm Tuesday Available Times menu Wednesday AM Shift - 9am - 1pm PM Shift 1pm - 5pm Full day Shift 9am - 5pm Wednesday Available Times menu Thursday AM Shift - 9am - 1pm PM Shift 1pm - 5pm Full day Shift 9am - 5pm Thursday Available Times menu Friday AM Shift - 9am - 1pm PM Shift 1pm - 5pm Full day Shift 9am - 5pm Friday Available Times menu Saturday AM Shift - 9am - 1pm PM Shift 1pm - 5pm Full day Shift 9am - 5pm Saturday Available Times menu Sunday AM Shift - 9am - 1pm PM Shift 1pm - 5pm Full day Shift 9am - 5pm Sunday Available Times menu Question Title * 11. If you are interested in becoming a foster carer please select the animal(s) you would be interested in fostering below. Cats Kittens Dogs Puppies Pocket Pets Livestock Question Title * 12. Please select the below if you are volunteering as part of Centrelink obligations or Education / Course placement Centrelink Obligations Vcal Education Placement General Course Placement Other (please specify) Question Title * 13. Any relevant past experience or skills that may be relvant to your volunteering Question Title * 14. Any further comments, questions or concerns Thank you for completing our online registration form. Someone from our Human Resources deaprtment will be in contact with you within the next 7 - 10 days. If you have any questions or concerns please feel free to contact Animal Aid on 97390300 Done