Child Protection Statement

Page 1 of 3

Contact Details

I attend the following Church

I mentor in the following School/s

Title

First Name

Middle Name (helpful for WWCC)

Last Name

Street Address

Suburb

State

Postcode

Email Address

Mobile Number

Date of Birth

Gender

Male

Female

Data updates: if any of these fields are incorrect or incomplete, please provide the updated details below (eg. name, email, church or school)

ContactID

AffiliationID

CPS ID

Primary Contact/Coordinator Email

Page 2 of 3

Working with Children Check Details

WWCC Number

WWCC Expiry Date

*This covers all States and Territories i.e. Working With Children Check Card (VIC/NSW/WA/ACT), Blue Card (QLD) , Working With Vulnerable People Card (TAS), Ochre Card (NT)

WWCC Issued Date

WWC details updated: if your WWC number or expiry date has changed, please provide it in the text box below and Kids Hope will update your data

Page 3 of 3

Child Protection Statement

My primary volunteer role for Kids Hope is

NB. If you are a Coordinator and Mentor, please select Coordinator as your primary Kids Hope role.

I have completed the Kids Hope training and agree to abide by the guidelines for my role.*

I have provided Kids Hope with my Working With Children Check number, including my date of birth, and consent to Kids Hope using this information to verify my Working With Children Check status.*

I have read, understood and agree to the Kids Hope Child Protection Manual, including the Code of Conduct and the Privacy and Confidentiality Policy.*

I understand that any action inconsistent with the Child Protection Manual and Code of Conduct may result in the termination of my role with Kids Hope.*

I will ensure I read all Kids Hope email communications and will not unsubscribe from these communications whilst I am an active volunteer.*

I understand that Mentors cannot mentor children unless they have completed their annual Child Protection Statements. So when required, I will provide assistance to ensure their timely completion.*

I am also a Mentor

Yes

No

Declaration Year