Tilmelding * Enrolment * Inscription * SOUTH AFRICA CAPE TOWN

TILMELDINGSFORMULAR * ENROLMENT FORM * FICHE D'INSCRIPTION

	Voluntary assistant in Cape Town
	Please fill out in English and press the SUBMIT button at the bottom of this page. Note: the SUBMIT button will only be clickable when you have accepted our terms and conditions. For voluntary social work enrolments send a mail to info@exis.org with your CV and a personal letter of motivation explaining why you are interested in working as a volunteer and stating any previous experience.
Date:
First name:
Last name:
Full address:
Country:
Telephone:
E-mail:
Nationality:
Passport number:
Education:
Birth date:

Special qualifications:

How long have you studied English?	years months

Work experience:

Do you smoke?	yes
	no


Are you under any medical treatment, if yes, please specify!

Are you vegetarian or vegan?	yes
	no

Expected arrival date:

Duration voluntary work:	I would like to follow 1 week preparation activities and outings and would like to give voluntary assistance for a duration of:
	4 weeks
	5 weeks
	6 weeks
	7 weeks
	8 weeks
	9 weeks
	10 weeks
	11 weeks

Voluntary work choice:	Please give 3 priorities. Final choice is made in Cape Town.
	A1 Shelters for street children or youth/adults
	A2 Red Cross Children's hospital or another hospital
	A3 Kindergarden
	A4 School for handicapped children
	A5 Shelters for mothers and their children
	A6 Animal casualty clinic
	A7 Fountain House
	A8 Kiddies College
	A9 Dominical Deaf School
	A10 Feedback project
	A11 Child Welfare Organization
	A12 Give and Gain
	A13 Help2Read
	A14 Shine Centre

Travel together?	Do you wish to travel together with other students if possible?
	yes
	no

	If you want to travel with a friend, please state his/her name:


Savannah trek?	Do you wish to participate in a Savannah trek before returning home?
	yes
	no


Who to contact in case of emergency (i.e. parents):

Names:

Address:

Telephone:

E-mail:

Comments:

How did you find Exis?


		Remember to mail the following document : Letter of motivation, stating why you would like to volunteer and if you have any relevant experience or personal interests.