All Saints Home Volunteer Registration Form

Medical Record

Do you have any existing medical condition, physical impairment or substance dependence (i.e. dependence on alcohol, drugs, etc., excluding prescription by a certified medical professional)?
[您现在或曾经是否被诊断出任何身体或精神疾?]

No [没有]

Yes [有]

Conflict of Interest

Are you affiliated and/or have dealings/transactions with any vendor, supplier or any other party who is providing or bidding to provide service to All Saints Home?
[您本人，直属或亲属是否附属正在为众生之家提供服务（如：供应商、承包商）或者有意竞标而为众生之家提供服务?]

No [没有]

Yes [有]

Measles, Mumps & Rubella (German Measles) MMR Vaccination
麻疹, 腮腺炎, 風疹［德國麻疹］疫苗

Have you been vaccinated against MMR?
[您是否已完成接种MMR混合疫苗?]

No [没有]

Yes [有]

I agree to the terms and conditions as listed in this link.
[我同意所列的条款和条件]

I consent to All Saints Home photographing and videoing me during any activities in which I participate as a volunteer and using such photographs and videos, together with my name, in newsletters, websites, or other marketing and/or publicity materials without any payment to me
[我同意众生之家在我参与的任何活动中对我进行拍照和录像，并在通讯、网站或其他营销和/或宣传材料中使用这些照片和视频，连同我的姓名，无需向我支付任何报酬]

Note: I am aware that I am able to withdraw the above consent at any time
[提示：我知道到我可以随时撤回上述同意]

I would like All Saints Home to keep me updated on: (please tick accordingly)
我希望众生之家能随时告知我最新情况：（请相应地打勾)

Upcoming Fundraising [即将举办筹款活动]

Upcoming Events [即将举办的活动]

Time [时间]	Mon [星期一]	Tue [星期二]	Wed [星期三]	Thu [星期四]	Fri [星期五]	Sat [星期六]	Sun [星期日]
Morning (9.30 am – 11.00 am)
Afternoon (2.30 pm – 4.00 pm)

All Saints Home (Jurong East) 众圣之家（裕廊东） 20 JURONG EAST AVENUE 1, S609792 Tel: 6819 9300	All Saints Home (Hougang) 众圣之家（后港） 5 POH HUAT ROAD, S546703 Tel: 6282 6969
All Saints Home (Tampines) 众圣之家（淡滨尼） 11 TAMPINES STREET 44, S529123 Tel: 6788 2345	All Saints Home (Yishun) 众圣之家（义顺） 551 YISHUN RING ROAD, S768681 Tel: 6351 1400
All Saints Silver Lifestyle Club @ Yishun Central 众圣乐龄生活俱乐部@义顺中心 YISHUN POLYCLINIC (U/C), 2 YISHUN AVENUE 9, S768898 Tel: 6351 1460	All Saints Silver Lifestyle Club @ Yishun Fern Grove 众圣乐龄生活俱乐部@义顺Fern Grove FERN GROVE @ YISHUN, 674 YISHUN AVENUE 4, S760674 Tel: 6351 1470

Volunteer Registration Form

Volunteer Details

Contact Details

Residential Details

Emergency Contact Details

Background Information

Language Details

Volunteering Details

Interested Area (s) of Befriending / Volunteering [首选的服务项目]

Declaration [声明]

Statement of Undertaking [协议声明书]