1. I declare that the information contained in this application for volunteer work is true and correct.

2. I, the undersigned agree to give permission for my photograph and name to be used by Gold Coast Hospital Foundation for its promotional purposes, and give my express consent to Gold Coast Hospital Foundation to collect, use and diligently maintain my personal details.

3. In the case of an emergency, I authorise Gold Coast Hospital Foundation staff, volunteers or contractors to arrange for me to receive such medical or surgical treatment as may be deemed necessary.

4. I understand that the information I am supplied with as a volunteer is private and confidential and I will not take or use the information for any other purpose.

5. I am 18 years and over.