Volunteer Application | KUKUA PAMOJA TANZANIA

NAME*

PHYSICAL ADDRESS *

DATE OF BIRTH *

PLACE OF BIRTH*

NATIONALITY*

YOUR EMAIL *

TELEPHONE NUMBER *

NAME OF EMERGENCY CONTACT PERSON*

EMERGENCY TELEPHONE NUMBER*

EMERGENCY EMAIL:*

VOLUNTEERING INFORMATION*

CHOOSE ONE YOUR DESIRED VOLUNTEERING PROGRAM

Children Sponsorship Program

Women Economic Empowerment

Football Program

Environmental Initiatives

Orphanage Centers Food Security

Family & Friends

START DATE*

END DATE*

LANGUAGE PROFICIENCY*

English

Others

OTHER LANGUAGES

SKILLS*

ACCOMMODATION OPTIONS

Single Room

Dorm

DO YOU REQUIRE A SPECIAL DIET OR DO YOU HAVE ANY ALLERGIES?

Yes

No

IF YES, PLEASE GIVE US MORE INFORMATION:

ADDITIONAL INFORMATION

YOUR EXPECTATIONS

MORE

IF OTHER PLEASE SPECIFY

DO YOU HAVE ANY MEDICAL CONDITIONS THAT WE SHOULD BE AWARE OF?

Yes

No

IF YES, PLEASE DESCRIBE

DO YOU HAVE ANY ALLERGIES?

Yes

No

IF YES, PLEASE DESCRIBE

DO YOU HAVE TRAVEL INSURANCE?

Yes

No

IF YES, PLEASE PROVIDE THE NAME OF THE INSURANCE PROVIDER AND POLICY NUMBER

VOLUNTEERING APPLICATION FORM

REGISTRATION

By filling out this registration form, you are making a binding registration with us. Within three working days, we will get in touch to discuss details and send you your confirmation.

PERSONAL INFORMATION

I have read and agreed to the terms and conditions

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P.O.BOX 15652, Ilikiurei-Mianzini Street, Kiranyi Ward, Arumeru District, Arusha Tanzania | Registered under the Tanzania NGO Act of 2002, Registration Number: ooNGO/R/3308

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