Welcome to the Samford Support Network
Membership Application System
Last updated: 24 March 2022 11:37 (NewMDB, Public)
Thank you for your interest in being a part of the Samford Support Network. The Samford Support Network (SSN) will use this form to collect information about a person wishing to become a member of the Samford Support Network.
The membership application process follows 4 simple steps:
Having a medical condition or illness does not necessarily preclude you from undertaking a particular role, but rather allows the SSN to support you in undertaking your role safely and appropriately.
Your application must be processed by SSN before you are considered a member. Please be aware that you are not covered by any of the protections offered to SSN volunteers, such as insurance, until you have received written confirmation of your membership from the SSN Management Committee.
Privacy Notice: Your personal information is protected by law, including the Privacy Act 1988, and is collected by the Samford Support Network Inc for the administration of your membership of the SSN, payments and services. Your information may be used by the SSN Management Committee and may be seen by advisors to the SSN (for example, for legal, accounting, audit purposes), our partners, or where you have agreed, or where it is required or authorised by law to be disclosed.
Lets get started:
You can start a New Application for Membership of the SSN by clicking Step 1 here.
After you have completed Step 1, you will be provided with your unique VID number from Step 1 by the Membership Coordinator and can then complete the remainder of your application details by following Step 2 here.
If you have any questions or need help with completing this form, please email SSN on SSN@samfordsupportnetwork.com or call the SSN phone number 0470 214 916.
|SSN Member Application Form|
Step 1: Basic contact details
If you require more information or have any questions, please contact one of the SSN Management Committee at SSN@samfordsupportnetwork.com or by calling the SSN phone number 0470 214 916.
This is STEP 1 of your application to be a member of the SSN. Please provide as many of the details as you can below and press the Green "Submit Form" button.
A confirmation email will be sent to you, and our Membership Coordinator will contact you within 7 days.
Step 2: Complete the remainder of the Application
This is Step 2 of the SSN Member Application Process.
By now you should have spoken with the SSN Membership Coordinator, given your unique VID number and advised to proceed to Step 2.
Please complete as much information in the additional fields below and press the Submit Form button.
|MEMBER CONTACT DETAILS|
|Full Name (given)|
|Full name (preferred)|
|Address Line 1|
|Address Line 2|
|Suburb||(You must reside in one of these Suburbs.)|
|Date of Birth|
|Date of Application|
|Date of MC Approval|
|Police Check completed|
|Code of Conduct Signed|
|Photo ID Card issued|
|Consent to use photos|
|MEMBER VEHICLE DETAILS|
SSN Policy for Member Vehicles:
To limit vicarious liability of the Samford Support Network, and for the protection of SSN Members, SSN Clients and the community, ALL SSN Members (whether they drive Clients for the SSN or not) who use a car are required to have an open drivers licence and only use roadworthy vehicles covered by a Comprehensive Vehicle Insurance Policy and are currently registered. Third Party Only insurance cover is not acceptable to be an SSN Member with a car.
|First Aid Training expiry date||(Note: This is optional and not a requirement to become a Member.)|
|QAS CPR Awareness date||(Note: This is optional and not a requirement to become a Member.)|
|Skills and Experience|
|Fully COVID Vaccinated?||(Note: This is optional and not a requirement to become a Member.)|
|Date of latest Vax update||(Note: This is optional and not a requirement to become a Member.)|
|EMERGENCY CONTACT DETAILS|
|Emergency Contact first and last name|
|Emergency Contact Address 1|
|Emergency Contact Address 2|
|Emergency Contact Suburb|
|Emergency Contact Postcode|
|Emergency Contact Home phone|
|Emergency Contact Work phone|
|Emergency Contact Mobile phone|
|Emergency Contact email|
Optional - Please tick your initial areas of Interest
(Hover your cursor over the item to read more information.)
|Brookside Shopping||Tick to express your interest in helping this service.|
|Client Support||Tick to express your interest in helping this service.|
|Client Transport||Tick to express your interest in helping this service.|
|Equipment Transport||Tick to express your interest in helping this service.|
|Emergency Pet Care||Tick to express your interest in helping this service.|
|Food Transport||Tick to express your interest in helping this service.|
|Fundraising and Events||Tick to express your interest in helping this service.|
|Handyman/Gardening||Tick to express your interest in helping this service.|
|In-Home support||Tick to express your interest in helping this service.|
|Client Social Outings|