Volunteer Application Form

Cycling Without Age Napier Trust Volunteer Application

Applicant name *

First name

Last name

Address

Address line 1

Address line 2

Address line 3

Address line 4

Town/Suburb

City

Postcode/Zip

Email address *

Mobile # *

Emergency Contact *

Name, relationship and phone number please

Date of Birth

Drivers Licence No:

Drivers licence expiry date

Police Check Date Completed

or Date applied for it at:
https://www.criminalrecords.govt.nz/Individual#

Vaccinations

Please make your Vacc record available to be seen.

Yes

Do you have a valid First Aid Certificate?

We may enroll you in a first aid course if you do not have a First Aid Certificate, kindly funded by Donors.

Yes

First Aid Cert Date

Upload ID or any other files

Wait..

Reasons for wanting to volunteer with Cycling Without Age Napier:

Other ways you might contribute to CWA Napier?

Admin, fund raising etc.

Do you have empathy, social and good communication skills?

Your empathy and social skills will be a huge asset when joining CWA Napier. Joyful and empathetic communications with your passenger will create a great outing for them

Please provide any additional information that you think may be useful in volunteering with CWA Napier

Please indicate the activities for which you would like to volunteer.

Pilot

Companion Rider

Social Media Assistance

Please expand on "Other" if ticked above

By word of mouth, friends, passengers or ........?

Will you abide by Cycling Without Age Guiding Principles of:

1. Generosity.
Pilots will be generous by the giving of their time freely to enable their passenger to enjoy the chance to feel the wind in their hair.
2. Slowness.
Slowness allows you to sense the environment and be present in the moment. It allows people you meet along the way to be curious and gain knowledge, because you make time to stop and talk.
3. Storytelling.
Older adults and those experiencing lonely journeys all have interesting stories to tell. Our pilots will listen, engage and through their stories retain those special memories.
4. Relationships.
The CWA service will cross many layers of society and create new relationships and inter-generational friendships between participants and pilots.
5. Without Age.
Life evolves at all ages, young and old and can be thrilling, fun, sad, beautiful and meaningful. CWA is about letting people age in a positive context.

Your Agreement to GUIDING PRINCIPLES *

Yes

The most powerful testimony for our service is in the words of our passengers:

“It is just so nice to be IN the neighbourhood, looking at everything up close.”

When asked how the rides made him feel, he answered “Free!”

Please check if you agree you ..........

Feel comfortable assisting seniors in and out of the triobike? box

"Feel comfortable assisting mobility challenged people in and out of the triobike?

Do you have a mobile to use in case of an emergency?

Do you have any experience in basic cycle maintenance?

Yes

Is your Cycling Experience with Standard or Electric bikes? This is asked to better assess the training support required.

The Trishaws are very stable and with the electric assist relatively easy to ride at the required slow speed.

Do you have any other Associations/Memberships?

Any medical/physical condition that may affect your ability to participate in CWA Napier? *

Signature *