Fields marked with * are compulsory

NOTE – these questions are designed to give us more information about you so we can ensure we give you the correct training and support. They are not requirements to become a volunteer for FitSkills21.

We’d like to get to know a bit more about you and the things you enjoy doing in your spare time. 

We will use this information to help the FitSkills21 participant get to you know you.

The Pre-exercise Screening Assessment lets us know that is it safe for you to exercise.

This screening tool does not provide advice on a particular matter, nor does it substitute for advice from an appropriately qualified medical professional. No warranty of safety should result from its use. The screening system in no way guarantees against injury or death. No responsibility or liability whatsoever can be accepted by Exercise and Sports Science Australia, Fitness Australia or Sports Medicine Australia for any loss, damage or injury that may arise from any person acting on any statement or information contained in this tool.

AIM: to identify those individuals with a known disease, or signs or symptoms of disease, who may be at a higher risk of an adverse event during physical activity/exercise. This stage is self administered and self evaluated.

IF YOU ANSWERED ‘YES’ to any of the 7 questions, please seek guidance from your GP or appropriate allied health professional prior to undertaking physical activity / exercise. 

The FitSkills21 Program Manager will be in contact with you.

If you answered ‘NO’ to all of the 7 questions, and you have no other concerns about your health, you may proceed to undertake light-moderate intensity physical activity/exercise.

To ensure the safety of its participants and to meet its legal obligations, Down Syndrome Victoria must screen all volunteers.  You will need to  provide 100 points of identification, undergo either a Police Check or an NDIS screening check, and a Working with Children Check (if the role involves working with children under 18 years of age). DSV will also need to check your Right to Work in Australia and complete a Victorian Disability Workers Commission check.

We will be in contact with your nominated referees after you have submitted your form. Please let them know that Down Syndrome Victoria will be contacting them for a volunteer referee check.  Please provide two references who are able to provide evidence of your suitability for this position including one professional referee. For impartiality, please do not list your partner/spouse or relative as a referee. 

Please feel free to discuss any part of your registration with your staff contact

Do you have any actual, potential or perceived conflict of interest to declare prior to volunteering for DSV? 

A conflict of interest could occur when  personal interests and volunteer duties or responsibilities differ.

Conflicts of interest could include any current employment or volunteering within the disability sector, or a family relationship with a person with a disability or with Down syndrome.

All volunteers must complete the conflict of interest declaration below

Please note, if your circumstances change in the future and you believe that a conflict of interest occurs you must update this declaration by notifying DSV's volunteer coordinator.

• Your personal details are treated in the strictest confidence. The information is securely stored and will not be disclosed to any other party.

• Down Syndrome Victoria respects your privacy. Down Syndrome Victoria does not sell, rent, share or disclose your details under any circumstances.

• I hereby undertake that I will not, during or at any time after my work with Down Syndrome Victoria, divulge to any person without the express authority of the CEO of Down Syndrome Victoria, any information of a confidential nature (including information as to the name, address or other particulars leading to the identification of any person) which I obtain during the course of my volunteering.

• If I am legally compelled to disclose any confidential information, prior to making any disclosure I will notify the CEO of Down Syndrome Victoria so that DSV may, in its absolute discretion, seek a protection order or other appropriate remedy.

• I further undertake that I will not copy, or allow to be copied, without the prior written consent of Down Syndrome Victoria any confidential information and will return any confidential information and all copies, notes and other records of confidential information to DSV immediately on being requested to do so by DSV.

• I certify that the above information is true and correct and that if any of my details change I will notify DSV.

• I agree to have this information securely stored on file and on DSV’s Volunteer Database and that relevant  information may be disclosed in an emergency situation.

• I agree to abide and conform to all policy and procedures established by DSV.
  

• I understand that I am covered by DSV’s personal accident and public liability insurance while performing my agreed function as a registered volunteer.

• I accept the volunteer position as outlined in the role description. I have read the conditions and agree to them.

• I understand that I may be asked by DSV to discontinue my association with them if I am found to be in breach of any of these conditions
  

Any person under the age of 18 years, must have their parent or guardian sign this release in order to volunteer at a fundraising event

If yes, a parent / guardian is required to sign on your behalf

Do you need to apply for a Working With Children Check? 

note: the link opens in a new tab, you will need to return to this form and click submit at the bottom of the page

Apply Here!

Do you need to apply for the NDIS Worker Screening Check?

note: the link opens in a new tab, you will need to return to this form and click submit at the bottom of the page 

Apply Here!

DOWN SYNDROME VICTORIA 552 Victoria Street, North Melbourne, 3051 

P: 1300 658 873 F: 03 9486 9601 E: info@dsav.asn.au