Biodiversity and Endangered Species Team
ABN 53-424-857-283
a member of Friends of Park Inc.
Thank-you for joining the BEST Community Group. Please take the time to accurately fill out this registration form.
Please tick the appropriate boxes.
Name: ______
Address: ______
Phone number: ______Mobile number: ______
Email: ______
Date of birth (dd/mm): ______Age: 15-20 ÿ 21-30 ÿ 31-50 ÿ 51-70 ÿ 71+ ÿ
Preferred method of contact (for newsletter and activity information)
Email ÿ Post ÿ Phone ÿ Best time to call:______
Emergency Contact Person:______Relationship:______
Mobile: ______Phone (work): ______Phone (home):______
Logistical information:
ÿ I have my own vehicle (or access to a vehicle)
ÿ I am able to provide transport to other BEST volunteers
Reasons for joining the BEST group:
ÿ Help local threatened species
ÿ Gain 'hands-on' conservation experience
ÿ Learn new skills
ÿ Spend time outdoors
ÿ Meet new people
Do you have any particular skills or experience we should note when organising activities? ______
PLEASE READ AND SIGN AT THE BACK
MANAGEMENT PLAN FOR PRE-EXISTING INJURY OR MEDICAL CONDITION.
Do you have any medical conditions, allergies, disabilities or past injuries that may affect your participation?.
No ÿ Yes ÿ- Please describe ______
______
Information about the Condition/Injury
How serious is the condition if aggravated?
ÿ Potentially life threatening
ÿ Could require medical (doctor, hospital) treatment
ÿ Could require own medication
In your own words tell us how we recognise that your condition has recurred or been aggravated.
______
______
What actions, triggers or situations do you need to avoid?______
______
What is the management plan to minimise any aggravation to the condition/injury? Eg. self medication, avoidance of allergy triggers (specify) etc.______
______
Do you carry medication with you?______
Where is it stored? eg car glovebox, in pocket, in backpack etc. ______
CONDITIONS OF PARTICIPATION:
I agree to comply with the following terms that refer to my participation in all projects and activities:
ÿ I have notified the Project manager of any relevant medical conditions and pre-existing injuries, and I consent to the Project Manager rendering or authorising such medical treatment as necessary.
ÿ I shall co-operate with the Project Manager to ensure a safe, happy and respectful team environment.
ÿ Photographs or videos taken of me on a project may be used by DENR for promotional purposes.
Volunteer
Signature______Name______Date______
Staff Member
Signature______Name______Date______
Contact: Volunteer Support Ranger
Phone: 8841 3446
Post: BEST
Unit 3 / 17 Lennon Street
Clare SA 5453
Email: