Volunteer Registration Form

Salutation
First Name
Middle Name
Surname
Nationality

NRIC No
Gender Male    Female
Race
Religion
Date of Birth (dd/mm/yyyy)
Marital Status
Blood Group
Contact No
Language (Written)
Language (Spoken)
Email
Employment Information (Organisation and Position)
Home Address
Highest Qualification
Name of Next-of-Kin
(Specify relation)
Next-of-Kin Contact No
How did you know about Cerebral Palsy Alliance Singapore (CPAS)?
Do you have relatives/friends currently employed by CPAS? (Please indicate name and relationship)
Do you have any medical history that may prevent you from safely doing the task you are applying for? If YES, please state your medical condition.
Have you ever been detained by the police and/or convicted in the court of law? If YES, please provide details.
Do you hold any types of medical certifications?
Physician  Nurse  Dentist  First Aid  Other (please specify)
Medical License/Certification Number:
Expiry Date:
Have you provided your services to any volunteer organisation? If YES, please specify the capacity of volunteer work.
Day Monday  Tuesday  Wednesday  Thursday  Friday
Time 8.30am-12.45pm  12.30pm-4.45pm
Duration Long Term (More than 12 months) Short Term (6 months) Trial Term (Minimum 10 weeks)
Service Events & Outing   Classroom Activities   Hydrotherapy   Fundraising   Administrative Support   Multimedia (Videography & Photography)   Others (please specify)
Skills Graphic Design Photography Swimming Emcee Arts & Craft Others(please specify)
Venue Cerebral Palsy Centre (65 Pasir Ris Drive 1)
Early Intervention Programme for Infants and Children (EIPIC)@630 (Blk 630, opposite Cerebral Palsy Centre)
 

This Code of Ethics serves as a fundamental framework and general guide for all volunteers:

  1. Respect your beneficiary as an individual

Each beneficiary is an individual with his/her values, religion, customs, and socio-economic status. You should never impose your belief/value system. Respect your beneficiary’s opinion, and that of his/her family.

  1. Confidentiality of Information

Your relationship with your beneficiary is based on trust. Please uphold the family’s right to privacy and keep strictly confidential all information shared by your beneficiary or his/her family.

Please do not disclose, discuss, publish (e.g. on your personal website, Facebook, etc) or broadcast information (including photographs) any aspect of your beneficiary or his/her family to any individual not affiliated to related VWOs, unless written permission is given in advance from the VWO.

  1. Sensitivity

While we appreciate your interest/willingness to help your beneficiary or his/her family, we discourage volunteers from offering money or material assistance (eg. food, toys, etc). Please consult the organisation’s staff if you are asked.

  1. Public duties, private interest

A volunteer shall not:

  1. Directly or indirectly make use of any official information or his/her position to further his/her personal interest

  1. Directly or indirectly use or allow others to use the name of the organisation or his/her position as a volunteer to support his/her own cause

  2. Abuse the relationship with the child or family for profit, prestige or any other motive

  1. Discharge of Duties

You should accept all duties with responsibility and care. Your beneficiary should never be left unattended while in your care.

  • Do not smoke in front of your beneficiary.

  • Must not use inappropriate language and behaviour.

  • No volunteer is allowed to use physical force to discipline a beneficiary (eg. hitting, slapping, etc.)

  • Do not administer medications without consulting the staff.

  • Be alert and ensure your beneficiary does not engage in dangerous activity that may cause injury or harm to himself/herself or others. Notify staff immediately if any injury happens.

Do notify the staff-in-charge or volunteer coordinator of any issues that may require attention and/or professional intervention.


I confirm that all information submitted by me on this application is accurate.

I am liable for my own safety and belongings when I am volunteering at Cerebral Palsy Alliance Singapore (CPAS) and hereby release, and discharge CPAS against any claims for injury or lost/damaged.

I agree to adhere to the volunteer code of ethics and understand that if any false information, omissions or misrepresentations are found, my application may be rejected and active volunteer status may be terminated at any time.

I agree to give consent to Cerebral Palsy Alliance Singapore (CPAS) to contact my references, any previous employers and supervisors of my volunteer commitments.

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