NHWNT Email Marketing -

Volunteer With Us!

Thank you for choosing to volunteer with Neighbourhood Watch NT. We appreciate the time and effort taken in completing the online registration form and we look forward to welcoming you as part of our valued team!

First Name*

Last Name*

Email*

DOB YYYY/MM/DD*

Country of Birth

Phone*

Residential Address*

Suburb*

NT Region*

Ochre Card Number*

Ochre Card Expiration Date YYYY/MM/DD*

Why do you want to volunteer with NHWNT?*

Please detail any other skills or interests

MEDICAL INFORMATION - Neighbourhood Watch NT has a duty of care to protect your health and/or safety when you volunteer. It is important that you declare any medical information so that you are covered by the Neighbourhood Watch NT insurance whilst performing volunteer activities. Do you have an existing medical condition/injury or disability that may affect your ability to perform duties? *

Yes (please provide details below)

No

Details of any medical conditions/injuries or disabilities

Do you currently take any medication that may affect your ability to perform duties safely? *

Yes (please provide details below)

No

Details of any medication

Emergency Contact Name*

Emergency Contact Phone Number*

Emergency Contacts Relationship to You*

DECLARATION - I declare that the information provided in this application is true and correct.*

I agree

I agree to inform Neighbourhood Watch NT if my circumstances change at any time and understand that I may not be eligible for insurance if I fail to declare any information that may impact my ability to perform duties safely.*

I agree

I confirm that I have read and understood the Neighbourhood Watch NT code of conduct and I agree to abide by this whilst representing Neighbourhood Watch NT*

I agree

I understand that I am volunteering my services and will not receive any remuneration.*

I agree

I consent to Neighbourhood Watch NT taking and using photographs of me for NHWNT promotional items including but not limited to social media postings, e-Newsletters, and printed merchandise.*

I consent

I do not consent