Volunteer Registration Form

Please give us details if you know the role or type of volunteering you would like to do. (Please look at our webpage: www.adasa.org.za as we provide guidance and support to people living with dementia and their caregivers, and some applicants may not wish to serve in this field. Volunteering is an activity that involves giving time, being unpaid and doing something that aims to benefit the environment, individuals, or groups).

Volunteering for ADASA

How regularly do you wish to volunteer?

How Often

Monthly Weekly More Often

Have you volunteered before? If so, please provide details

When will you be available to start volunteering?

Please provide the hours you are available to volunteer.

Additional Information

Do you currently have a valid drivers license?

Drivers License

Yes No

If yes, do you have the use of a car?

Yes No

What interest, skills and experience could you bring to ADASA?

Why do you want to volunteer?

Language(s) spoken / understood / written

Are you computer literate?

Yes No

Have you previously worked with a person living with dementia?

Have you previously worked with a person living with dementia

Yes No

What type of dementia? E.g. Alzheimer’s Disease, Vascular Dementia, HIV-related dementia, etc

Volunteering with Disabilities

We welcome applications from volunteers with disabilities. Do you have any special requirements or health issues that you would like to tell us about or that may impact any activity you may be required to do?

References - Reference One

Please give us two references. Both should know you well and for a minimum period of one year. No family members will be accepted. We may only contact them if you are accepted as a volunteer at ADASA

Reference One Address

Reference One How do you know this person?

Reference Two Address

Reference Two How do you know this person?

Your personal details will be treated as confidential and kept for no longer than necessary. If you are accepted as a volunteer, the information you have provided on this volunteer registration and monitoring information form will become part of your volunteer records, which will be used to plan and record your practical involvement as a volunteer.

Please note that as a volunteer you will have access to all information, records, finances, and business models of ADASA. All information you have access to must always be kept private and confidential. By signing this document, you acknowledge that no information about any client or any of the ways in which ADASA runs will be allowed to be repeated; thus, non-disclosure is always expected, even once volunteering at ADASA is terminated.

Please note further that all emails from ADASA email addresses are monitored.

I know that my information will be treated confidentially and consent to be used and stored in the stated capacity. I confirm acknowledgement of non-disclosure that is always binding.

Status

Other (Please specify)

Volunteering Undertaking

Accpetance 2

I Accept the following

The information that you have provided is accurate to the best of your knowledge and belief. Should you be accepted to volunteer, you agree that you will not disclose to any person or organisation any information relating to ADASA, its clients, or activity undertaken by ADASA without previous consent. Under the Older Persons Act 13 of 2006, no photographs and videos are allowed to be taken and distributed of the elderly without written authorisation – infringement of this rule will immediately disqualify you as a volunteer. (Popi compliance applicable) In the event that you suffer an accident whilst working in a voluntary capacity, providing it is not due to negligence of the organisation concerned, you understand and accept that you are responsible for your own medical/surgical expenses.

The document will be signed during your interview with ADASA management.

Submitting this form doesn’t mean automatic registration as an ADASA volunteer. All applicants will be screened by either the regional manager or social worker. Thank you for your application.

Volunteer
Registration Form

Volunteer Registration Form

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Association for Dementia and Alzheimer’s of South Africa NPC (ADASA)

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