Applicant Details Title - Select - Mr Miss Other Full Name Preferred Name Date of Birth Gender - Select - Male Female Other Home Address Suburb Postcode Postal Address Leave blank if same as home address Suburb Postcode Unique Student Identifier (USI) Number What school do you attend? Are you Aboriginal or Torres Strait Islander? Aboriginal Torres Strait Islander No Emergency Contact Details (Parent/Guardian) #1 Full Name Relationship Contact Number Residential Address Email Emergency Contact Details (Parent/Guardian) #2 Full Name Relationship Contact Number Residential Address Email Current Qualifications If you currently hold any of the below, please provide copies (may not be relevant to all) NT Working with Children Clearance (Ochre Card) (If 15 years or older) NT Driving Licence (C Class) Immunisation record Provide First Aid Provide Advanced First Aid Provide Advanced Resuscitation Files Unlimited number of files can be uploaded to this field.5 MB limit.Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods. Acknowledgement As a volunteer member with St John Ambulance Australia (NT) Inc. I shall:Abide by current St John Ambulance Australia (NT) Inc. Policies, Procedures, and Code of Conduct.Continually maintain or update my skills and knowledge in First Aid, and Child Safeguarding practices.At 15 years or older, hold a valid NT Working with Children Clearance.Present a positive image of St John Ambulance Australia (NT) Inc. to the community.Notify St John Ambulance Australia (NT) Inc. immediately of the suspension of Working with Children Clearance, Driving License or any breach of Policies, Procedures or Code of Conduct.Return all Personal Protective Equipment (PPE), Uniforms, and Identification Cards issued upon my resignation from St John Ambulance Australia (NT) Inc. As a Youth member, I agree to abide by the above statements. As a parent/guardian of a Youth member, I agree to support my child's compliance with the above statements. Child SafeguardingSt John NT has zero tolerance for child abuse.St John Ambulance Australia (NT) Inc. is committed to the safety and wellbeing of all children and young people who participate in our activities, programs, events. services and patient care.We want children to be safe. supported, nurtured and empowered while involved in our programs and being cared for by our people. We will take a preventative, proactive and participatory approach to child safety.This commitment includes:Providing a child safe environment.Valuing the input of parents, guardians or carers.Respecting culturally and/or linguistically diverse backgrounds.We promise to: Foster a culture of openness without fear of repercussions, victimisation or retaliation.Provide St John Ambulance Australia (NT) Inc. members with education on child safety.As for consent from parents, guardians or carers. We take all allegations and concerns around abuse very seriously. We will always strive to ensure that children do not experience neglect, abuse, harm or exploitation during their involvement and interactions with St John Ambulance Australia (NT) Inc.St John Ambulance Australia (NT) Inc. Child Safeguarding and Wellbeing Code of Conduct Media Talent Release:St John Ambulance Australia (NT) Inc. may wish to take your photo or interview you for marketing and promotional purposes.Agreeing to the St John Ambulance Australia (NT) Inc. Media Talent Release grants us permission to use any photos, videos, audio recordings, or written information about your child for marketing materials, including on websites, social media or issued to the media. The content may be changed, cropped, or combined with photos of others. You will not be paid for the use of your childs' image, photos, videos or recordings.Permission is optional, your choice will be respected, and you may at any time remove your permission in writing to media@stjohnnt.asn.au. As a parent of a Youth member, I give permission and agree to the above Media Talent Release statements. As a parent of a Youth member, I do not give my permission and I do not agree to the above Media Talent Release statements. Medical Questionnaire Do you have any medical conditions which may affect you volunteering? If yes, please complete Youth Health Declaration - None - Yes No Do you have any Allergies? If Yes, Please Specify Code of Conduct As a member of St John Ambulance Australia (NT) Inc., a certain standard of behaviour is expected of you. Your actions reflect on St John Ambulance Australia (NT) Inc. This agreement is between you, (Member) and St John Ambulance Australia (NT) Inc. St John Ambulance Australia (NT) Inc. Code of Conduct As a Youth member, I agree to abide by the above Code of Conduct. As a parent/guardian of a Youth member, I agree to support my child's compliance with the above Code of Conduct. Declaration I hereby declare that all the information I have supplied in this application is correct and understand that any false declarations made above will invalidate my child's application. Full Name (Parent/Guardian) Parent/Guardian Signature Sign above Full Name (Youth Member) Youth Member Signature Sign above Where did you hear about us? Please select all that apply First Aid Training Course Facebook Instagram Newspaper Radio Other Department within St John NT Word of mouth Community Education Other If Other, please specify CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
