Volunteer Form

Become a Flame Volunteer

Name

First Name

Last Name

Email Address

Position Applied for

Preferred Location

Date Of Arrival

MM

DD

YYYY

Arriving From

Flight or Bus No.

Time of Arrival

Hour

Minute

Second

Pick up on Arrival

Yes

No

Date of Leaving

MM

DD

YYYY

No. of Hours per Week

No. of Days per Week

Gender

Date of Birth

MM

DD

YYYY

Place of Birth

Nationality

Present Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Passport No.

Passport Issue Date

MM

DD

YYYY

Passport Issued by

Emergency Contact Name

First Name

Last Name

Relationship

Emergency Contact Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact Tel

(###)

###

####

Emergency Contact Email

Martial Status

Single

Married

If Single and Under 18 Fathers Name

First Name

Last Name

Father Telephone

(###)

###

####

Father Email

If Single & under 18 Mothers Name

First Name

Last Name

Mother Tel

(###)

###

####

Mother's Email

Legal Marriage Certificate

Yes

No

Spouse's Name

First Name

Last Name

Spouse's Occupation

Spouse's Company Name

Spouse's Phone

(###)

###

####

Spouse's Email

Number of Children

Health and Accident Insurance Provider

Our goal is for you to have a safe and enjoyable time while visiting/volunteering at Flame Cambodia. In the unlikely event of a medical emergency or accident, Flame Cambodia does not have the resources to manage this situation and therefore the responsibility rests solely with the visitor/volunteer.

Insurance Policy No.

Other Information

Is there anything that we, as your host, should know about that may affect your ability to carry out volunteer tasks or visits to Flame sites (including any physical disability or serious illness)? Note that this can help us prepare for your visit/volunteer assignment.

Education

Include Start and end dates, Name of Institution, Major Area of Study and Qualification obtained.

Other Education

Include date of study, insititution and aubject of study

Special Interests, Activities and Hobbies

Please list any hobbies, activities and special iinterests not already mentioned

Khymer Language - Written

Please select your ability level

Khmer Language - Oral

Please select your ability level

English Language - Oral

Please select your ability level

English Language - Written

Please select your ability level

Other Language 1

Please list the other language

Other Language 1

Please select your level

Other Language 2

Other Language 2

Please select your ability level

Areas of Interest

What aspects of Flame are you particularly interested in?

Area of Interest Skills

What skills and abilities do you have that you would like to use to help Flame?

How did you hear about Flame?

What interests you most about volunteering with Flame Cambodia?

What are your long term goals, and how can volunteering at Flame Cambodia help towards those goals?

Flame Beliefs

Flame Cambodia is a Christian organization committed to serving the poor and practically demonstrating the love of God. It is not a requirement or assumption that visitors/volunteers are Christians but may be requested from time to time to attend Christian activities organized by Flame Cambodia. As a visitor/volunteer you are representing Flame Cambodia to the communities and clients we work with, and as such we require a standard of behavior that reflects the dignity and respect towards those we work among. We all strive to act in a culturally sensitive manner.

Child Protection Policy and Code of Conduct

As a child-focused organization, Flame Cambodia is committed to the protection of children. We therefore do not accept visitors or volunteers whose backgrounds are not suitable to work with children. All successful applications are conditional upon the completion of all applicable background checks, including criminal record checks. In the event of any illegal activity or conduct while in country, Flame is absolved from any responsibility. You will be sent our Child Protection Policy and Code of Conduct Policy once we have received this form. Please read and then email the signature page of the Child Protection Policy to info@flamecambodia.org. Please email to info@flamecambodia.org with Volunteer Application in the subject line your Curriculum Vitae and a Police Check or similar document from your country.

CV sent

Police Check/Criminal Record sent

Fees

Please note that there are Volunteer fees to be paid to help compensate Flame for the cost of administering your Volunteer assignment. The fee schedule for a visitor/volunteer assignment is USD $45/day per person up to a maximum of USD $200 per person, for up to two weeks. For a group of over four people, the rate is $200 per day. This covers the time and administration expenses of our staff. Transport, food and accommodation are not included in this fee. Details for transport and accommodation options can be provided upon request. The fee is to be paid on arrival at Flame in Cambodia or into the Flame NZ Bank Account. Account Number: 06-0222-0667759-00 Account Name: Flame Cambodia Bank: ANZ

Signature

Typing your name in this consititues that you have signed this form and the information you have provided is correct to the best of your knowledge

First Name

Last Name

Child Protection Policy