Volunteer registration form I hereby consent and agree that Community Canteen can contact me in relation to Community Canteen operations. My contact details that I authorise Community Canteen to use are:Email* Mobile*Other Emergency contact name Emergency contact number I give consent to Community Canteen to make, use and/or retain an image(s) and/or video(s) that may identify me, or the person for which I am the legal guardian, as named in ‘Participant Details’ below. I understand that I can withdraw or modify my consent at any time in writing to: amy@communitycanteen.com.au. If you have any restrictions you want to apply to the use of your personal information, you should list them here (e.g. cultural considerations, usage restrictions, expiry of consent, etc):Conditions/Restrictions I understand that by giving consent, Community Canteen becomes the copyright owner of the image(s)/video(s) and can use the image(s)/video(s) to promote Community Canteen and it’s work and activities. Community Canteen may reproduce and/or distribute the image(s)/video(s) in any form, in whole or in part, including but not limited to: print advertising and/or electronic published media (e.g. www.communitycanteen.com.au and other websites, Twitter, Facebook, Instagram, YouTube); electronic and printed mail-outs, commercial electronic, television and print media and advertising publications such as newsletters, brochures, flyers, posters, newspapers and magazines. I understand that Community Canteen: • will not pay me for giving this consent or for the use of my image(s); • may keep the image(s)/video(s) on record until I revoke my consent; • may use the images(s)/video(s) in the future, unless I specify limitations for its use; and • will not infringe the rights of any third party by exercising its rights given in this Consent. I authorise Community Canteen to edit, alter, copy, exhibit, publish, or distribute the image(s)/video(s) for any lawful purpose, and I waive any right to inspect or approve the finished product wherein my likeness appears. I agree to hold harmless, release, and forever discharge Community Canteen from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorisation. For the purposes of this consent form, the person whose image(s) is used is known as the ‘Participant’.Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone*Email* Current Blue Card Holder* Yes No Able to provide proof of Double Vaccination + Booster* Yes No Age of volunteer* Over 18 Under 18 I represent that I am at least 18 years of age, have read and understand the foregoing statement, and am competent to execute this agreement.Volunteer Name* First Last Full name of guardian (if consenting for a minor or person with a decision-making disability): As the guardian of the volunteer under 18 years of age, I have read and understand the foregoing statement, and am competent to execute this agreement on their behalf.Name First Last Name of guardian* First Last Date* DD slash MM slash YYYY Δ
