Bare Sand Island Volunteer Application Form
Your Name
Your answer
Full Address:
Residential Address ( Number , Street, Suburb, State, Post Code and country if outside Australia).
Your answer
Phone Number
Provide the country code if outside of Australia
Your answer
Your e-mail address:
Your answer
Date of Birth
MM
/
DD
/
YYYY
Trip Dates 2018
Trips depart on Monday mornings and return the following Monday afternoon
Yes
Trip 1: 11 June to 18 June
Trip 2: 18 June to 25 June
Trip 3:  25 June to 2 July
Trip 4: 2 July to 9 July
Trip 5: 9 July to 16 July
Trip 6: 16 July to 23 July
Trip 7: 23 July to 28 July
Emergency Contact: Name and address
This information is confidential and will be used only if there is an emergency
Your answer
Emergency contact phone number
Country and area code if not in Australia
Your answer
Can you swim?
Swimming ability is helpful but not essential. Open water swimming is not allowed due to crocodiles!
Dietary Preferences
This helps with catering for people on a remote island.
Vegan
Carnivore
Food Preferences
Please indicate your food preferences in the table below
not at all
in small amounts
in moderate amounts
in large amounts
fish
chicken
pork/bacon
kangaroo
beef
lamb
preserved meats (salami)
green vegetables
pumpkin
potatoes
onions / garlic/ spices
eggs
milk 
carbohydrates (bread, cakes)
Allergic Reactions
Required
Have you a medical condition that could be of concern on a remote island?
Your answer is confidential but important to the team leader. Please inform the team leader of any medical condition before you get to the island so that yo can be better accommodated
Please provide details of any medication and the need for storage
This is important for safe and effective storage of medicines.
Your answer
Is there anything else we should know that will be of concern on a remote island?
Read the information provided about the physical activities on the island.
Your answer
Do you give permission for photographs of you used in an educational context?
You will be contacted for media release approval in any resulting publication.
Do you understand and agree to your responsibilities and procedures for evacuation from the island if necessary?
Evacuations due to illness may incur a cost. It is best to have personal insurance.
Feel free to list your personal interests
This may assist in tailoring activities to the group
I have transferred the sum of Aus $50.00 to the AusTurtle Inc account as a deposit for participation. EFT can be deposited to Westpac Bank Casuarina, NT BSB: 035 306, Account Number: 231522. Include your name as the identifier in the transfer. Deposits will be refunded should your your application be unacceptable for any reason. Cancellations within three weeks of the departure date will not be refunded.
Please identify your deposit with your family name.
I have read and understood the Information Manual and agree to all conditions within. In addition you need to answer the following question. Within the past five years have you been guilty of a wildlife offence or had a permit cancelled under the Territory Parks and Wildlife Conservation Act or of an offence that otherwise relates to wildlife, including similar interstate legislation ?
Required for Nominees Assisting in the Research
Declaration:I do solemnly and sincerely declare that the details given above are true in every particular and I make this solemn declaration by virtue of the oaths Act.(Note there are heavy penalties for false declarations).
Signature: (You may type your name if electronic signature is not available).
Your answer
Date
MM
/
DD
/
YYYY
Submit
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