PHILIPPINE RED CROSS

Volunteer Service Office REGISTRATION FORM Recent

1 x 1 ID
National Head Quarters RC143 VOLUNTEER INFORMATION PROFILE Photo
INSTRUCTIONS: Please write clearly & legibly in BLOCK LETTERS and in black ink pen.
I. PERSONAL INFORMATION DATE OF APPLICATION:
Family Name: Given Name: Middle Name: Nick Name:

Sex: Date of Birth (mm/dd/yyyy): Age: Birth Place Religion Height (in cm) Weight (in kilos)

Civil Status: If married; Name of Spouse Contact Number Number of Children

Mobile Number: Landline Number: Email:

House No.: Street/Block/Lot.: District/Barangay/Village:

Municipality/City: Province: ZIP Code:

II. MEDICAL HISTORY

Pre-existing Medical or Health Conditions/ Disability/ Allergies (if any): Current Medications Taken (if any): Blood Type:

Emergency Contact Person (immediate family): Relationship to you: Landline Number: Mobile Number:

Emergency Contact Person other than the Immediate Family: Relationship to you: Landline Number: Mobile Number:

III. FAMILY BACKGROUND

Father’s Name: Age: Occupation:

Mother’s Name: Age: Occupation:

Number of brothers and sisters: Your Position in the Family:

IV. EDUCATIONAL BACKGROUND

Elementary: Year Graduated: Honors/Awards:

High School: Year Graduated: Honors/Awards:

College: Course: Year Graduated: Honors/Awards:

Vocational: Year Graduated: Honors/Awards:

Higher Studies: Year Graduated: Honors/Awards:

IX. TALENTS AND SKILLS

What would you consider as your talent(s)? What are some skill(s) you possess? Language(s) & dialect(s) you can speak, read and
understand fluently:

V. SOCIO-CIVIC, CULTURAL & RELIGIOUS INVOLVEMENTS

Organization/Activity: Position: Year:

Organization/Activity: Position: Year:

VI. WORK EXPERIENCE

Company Name: Title/Position: Year:

Company Name: Title/Position: Year:

VII. RED CROSS EXPERIENCE
Are you a Red Cross Volunteer? Month and Year Started: Do you have a Membership with Accident Assistance Benefits? If yes, MAAB Serial No.: Validity Period:

YES  NO  YES  NO 
Underwent Basic Volunteer Orientation Course? If yes, what year? Underwent Basic RC143 Orientation Training? If yes, what year?

YES  NO  YES  NO 
Other Red Cross Training/ Courses Acquired: Exclusive Dates:

VIII. REFERENCES (Kindly give us at least 2 persons that could recommend you.)
[1] Complete Name Contact Number(s) Company/Institution/Organization Position

[2] Complete Name Contact Number(s) Company/Institution/Organization Position

IX. SIGN UP AGREEMENT

Sign me up! By checking this box below, I agree I want to receive news, offers, tips, and other promotional materials from
and about the Philippines Red Cross, including by email, phone, and mail to the contact information I am submitting. I
consent to the Philippine Red Cross, its affiliates, and service providers processing my personal data for these purposes,
and as described in the Privacy Policy. I understand that I can withdraw my consent at any time.

YES, I Agree Please Sign Me Up NO, I Don’t Agree Why:

X. VOLUNTEER WAIVER
I am aware that by joining the volunteering activities with Philippine Red Cross, I am expected to conduct myself properly and be
responsible for my actions and I am obliged to follow all the rules and regulations implemented by the Philippines Red Cross. I also
agree to serve on a voluntary basis, without remuneration, and to hold the PRC free from any and all claims which may arise in
connection with my volunteer work with the Red Cross.

I hereby therefore release, waive, discharge, hold harmless and indemnify Philippine Red Cross, its officers, employees, faculties,
board members, and agents from all liability to myself for any loss or damage, and any claim or demands therefore on the account of
injury to my person or property due to my own negligence, imprudent demeanor, reckless conduct and/or irresponsible actions.

Nonetheless, I appeal to & trust that PRC Volunteer supervisors, managers and supervising staff on their part will exercise the due
diligence and prudence required for the over-all conduct, safety and security of my well-being to the best of their abilities at all times.
This diligence would include oral and written instructions, whether given before or during the activity that if followed, would ensure my
general safety.

This waiver is made freely and willingly without reservation whatsoever and do so with full knowledge of the possible risks involved.

____________________________________________________________ _______________________________________________________ __________________________________

Complete Name Signature Date and Place

XI. CERTIFICATION & CONFIDENTIALITY To be filled up by the Volunteer Service Office Staff
Please read the following carefully before signing this form REFERENCE CHECK
NAME OF PERSON CONTACTED COMPANY/INSTITUTION/ORGANIZATION

I hereby certify that the information provided by me in this

registration form is true, correct and complete to the best of
CONTACT NUMBER DATE
my knowledge. I further certify that I have and will answer all
questions to the best of my ability and have not and will not
withhold any information that would unfavorably affect my
COMMENTS / OBSERVATIONS
volunteering application. I understand that the information
contained on my application will be verified by Philippine Red
Cross and that it may require a reference check and/or
criminal check and hereby authorize such a check to be
conducted. As well as giving consent to use the given
information for the screening & selection process with the
guidance of the Data Privacy Act (RA10173). I hereby agree
to abide by all the Seven (7) Fundamental Principles of the OVER-ALL EVALUATION FINAL DECISION
International Red Cross & Red Crescent Movement, policies
and guidelines of the organization and the rules and
regulations of the training program. As well as giving consent Highly Recommended
ACCEPTED
to use the given information for training purposes with the Recommended
guidance of the Data Privacy Act (RA10173). I understand
that false information, misrepresentations or omissions may NOT Recommended REJECTED
be a justification for my immediate dismissal from the
volunteer program.

______________________________________ ___________________________________ ______________________________________ ________________________________________

SIGNATURE OVER PRINTED NAME DATE / PLACE VS Staff / CSR Head of Office
SIGNATURE OVER PRINTED NAME SIGNATURE OVER PRINTED NAME