Contact Details
Referral Details Form
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Email *
Hello! My name is Blaze Pilgrim and I am the Youth Coordinator at Southern Volunteering. I have prepared this form to collect some information about you so that I can remotely match your interests, skills and knowledge with volunteer roles closest to you.
If you struggle to fill this in, ask someone you know for help, or call us on 8326 0020 and I can fill it in for you whilst we chat over the phone. By filling this form in you are not being expected to do anything, you are merely expressing your interest in finding out what opportunities are out there which you will receive via email (generally between 2 and 14 days).
What is your first and last name (please feel welcome to include your preferred pronoun and / or your preferred name after your legal name in brackets) *
Date of Birth *
MM
/
DD
/
YYYY
Address (or if No Fixed Address list the suburbs nearest to you) *
Postcode *
Your phone number *
Secondary Contact - Its important to include their full name, their number and/or email & describe their relationship to you (Parent, Guardian, Teacher, Support Worker etc.)
Preferred method of contact (Specify your preference of how you want to receive information, do you want it to go to your secondary contact or to your email address?) *
Do you currently have any of the following? *
Required
Please note!!
Most volunteer opportunities require at least a police check (this will not cost you anything as a volunteer).

If you have concerns about providing a police check because of having a criminal history, you are welcome to discuss (or not discuss) the specifics with one of our staff members who can explain in more detail that merely having a criminal history does not mean you are unable to volunteer. We encourage all people from all walks of life to explore volunteering.
If necessary, are you willing...?
Tell me a bit about yourself? *
Skills and or qualifications? *
Previous experience (work or voluntary)?
Hobbies, Interests or direction you would like to go in?
Do you identify as having a disability?  *
Are you from a non-english speaking background? *
Are you a job-seeker? (Or receiving a centrelink payment) *
Is there anything else you'd like to share / we need to know to support you in having a positive volunteering experience?
Continent of Origin / Country of birth? *
Do you identify as Aboriginal or Torres Strait Islander? *
Are you interested in any of the following tasks? (pick at least 3) *
Required
Are you interested in any of the following sectors? (pick at least 3) *
Required
I'm interested in knowing what opportunities may be suitable for: *
Required
I'd be interested in...? *
Required
I can make myself available during... *
Required
How did you hear about Southern Volunteering? *
Have you heard of WE DO, seek volunteering and go volunteer? *
I consent to my information being kept by Southern Volunteering (SA) Inc. for the purposes of communicating opportunities that may be suitable to me. *
I am of legal age (or have parental / guardian consent) to allow Southern Volunteering (SA) Inc. to share information collected in this form to relevant third parties. * *
Are you happy with the service that Southern Volunteering (SA) Inc. is providing? *
Not satisfied
Very satisfied
A copy of your responses will be emailed to the address you provided.
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