Rotary District 9660

Youth Volunteer Information and Declaration

Your Privacy and Data Security

This form asks for sensitive personal information because Rotary has a duty to keep young people safe. We treat that information accordingly.

  • Everything you enter is sent over a secure, encrypted connection (HTTPS).
  • Your declaration is stored inside Rotary District 9660's private Microsoft 365 environment, where data is encrypted and access-controlled.
  • It is seen only by authorised District Youth Protection Officers and the relevant program officers who assess your suitability.
  • Your information is used solely to assess and record your involvement in Rotary youth programs. It is not sold, published, or shared for any other purpose.
  • It is held and used in accordance with applicable privacy legislation and Rotary's privacy policy.

Questions about how your information is handled? Contact support@rotary9660.org.au.

Personal Details

Use your full legal name as it appears on official documents. Do not use nicknames or abbreviations.

Program Involvement

Personal References

Only one referee may be a Rotarian and none may be family members.

Reference 1

Reference 2

Reference 3

Police Check and Criminal History

Include details of any diversions or intervention orders.

Rotary Endorser

This person will receive an email with a link to review and endorse your declaration.

Declaration

I certify the following:

  • The information provided in this form is true and correct to the best of my knowledge.
  • I have read and agree to comply with the Rotary District 9660 Youth Protection Policy and all relevant Rotary International policies concerning the safety and welfare of young people.
  • I have contacted my referees and all are happy for Rotary to contact them.
  • I give my full permission for any of the referees listed above to be contacted by Rotary.
  • I consent to a criminal history check being conducted if required by Rotary District 9660 or the relevant program committee.
  • I understand that any false or misleading statements may result in the immediate withdrawal of my involvement with any Rotary youth program.
  • I agree to abide unreservedly by Rotary's decision as to my suitability.
  • I acknowledge that copies of this form and the results of Rotary's enquiries will be held by the relevant program manager.
  • I understand that my personal information will be held and used by Rotary in accordance with applicable privacy legislation and Rotary's privacy policy.

"Rotary" means Rotary International District 9660 Incorporated and any club, committee, or program operating within or under the authority of that district.

I have read and understood the above declaration and sign this form voluntarily.

Applicant Signature