Volunteer - Batavia | The Electric Lamb Mission

Volunteer Form

This form allows us to expedite the process of registering you as a volunteer. We will have to check all data submitted, so please do ensure that data entered is correct.

All data collected will only be used for this purpose, and only core Electric Lamb personnel will have access.

All fields are mandatory.

First Name:*

Last Name:*

E-mail:*

Address:*

Next of Kin:*

Emergency contact number:*

Nationality:*

Age:*

Current location: *

Gender:*
Male
Female

Passport Number:*

Is your passport currently valid for more than seven months?:*
Yes
No

Organizational Affiliation:*

Please list organizations (work, volunteer) you're involved in

Vaccinations?:*
Yes
No

Do you have all your vaccinations in place? (Typhoid, Tetanus, Hep A &B, Cholera, Flu, Malarials)

Experience & Training (medical, boat, trauma, volunteer):*

Indonesian Languages:*

Please list Indonesian languages (Achenese, Nias, Mentawai, Minang and Bahasa) you speak.

Boat Skills:*

Kitchen Skills:*

Pre-existing health problems/issues:*

Diet Issues:*

Motion Sickness::*
Yes
No

Select "yes" if you suffer from motion sickness or sea sickness.

Do you have all your vaccinations and are you taking malarials?:*

What can you bring to the mission?:*

Please also use this form to give us any other data you think we should have about you.

What are the dates when you will be available?:*

CV?:

If you want to send us a CV; simply mail us after submitting this form.

Island Aid Organization Volunteers

Volunteer Form