附件二

File No.

ST. JAMES’ SETTLEMENT

VOLUNTEER REGISTRATION FORM

  1. Personal particulars

Name : Sex : *Male/Female Age :

Telephone No. : E-mail address :

Address :

Status : *Student/Employed/Retired/Housewife/Others: (Please specify)______

(For student) Name of School : Class :

(For employed) Education level : Occupation :

Interests/skills : _____

  1. Who would you have like to serve?

□children(11 or below) □youth(12 to 25) □elderly □mentally handicapped □family

□community □ethnic minority □others: (Please specify)______

3.What kind of service you would like to offer?

□concern visit□program assistance□counter duty(e.g. toys corner, library)

□escort□repair assistance□instructors(specify: ______)

□child care□health check assistance□clerical work(data entry, statistics)

□tutorial□photography □others:

  1. Time available for providing volunteer service: (Please tick in appropriate boxes)

Time / Mon / Tue / Wed / Thu / Fri / Sat / Sun
AM
PM
Night

5.Have you ever participated in volunteer service? *Yes/No

*(if, yes, please state service nature and name of agency) :

6.How do you know our agency’s volunteer service?

7.Remarks :

Personal Information Collection Statement

St. James’Settlement undertakes to comply with the requirements of the Personal Data (Privacy) Ordinance to ensure that personal data kept are accurate and securely kept. The donor personal information will be used for receipting and issuing thank you letter purposes. St. James’ Settlement may use your personal data (name, telephone number, fax number, email and mailing addresses) for the purposes of providing you with information of St. James’ Settlement, fundraising appeal, activities / courses invitation as well as for feedback collection and related promotion purposes. However, we cannot use your personal data unless we have received your consent. Upon your request at any time and at no charge, we will cease to use your personal data for promotion purposes.Please sign on the right to indicate your agreement to such use of personal data as above.Should you find such use of your personal data not acceptable, please indicate your objection before signing by ticking the box below.

I object to the proposed use of my personal data as stated above.

Signature of Applicant : Date :

Signature of Staff : Date :

St. James’ Settlement

85 Stone Nullah Lane, Wanchai Tel: 2574 5201