Agency Application Form

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Agency Application Form

All fields are required except where indicated

Organisation Details

Service Focus:






















Is your organisation incorporated:
Is your organisation a not for profit organisation:
Note: street number and street name are needed for all addresses

Main Contact Person

 

Insurance Information

 
Public Liability:
Volunteeer personal accident:
If your organisation does not have insurance and you would like information on the Cockburn Community Insurance Program. Contact the Volunteer Resource Centre Coordinator on 9411 3499.

Related Pages

Contact

Address

City of Cockburn
Whadjuk Boodja
9 Coleville Crescent,
Spearwood 6163

PO Box 1215, Bibra Lake DC,
Western Australia, 6965

Office opening hours:
8.30am to 4.30pm
Monday to Friday (excluding public holidays)

Language Support

Social Media

Cockburn Nyungar moort Beeliar boodja-k kaadadjiny. Koora, yeyi, benang baalap nidja boodja-k kaaradjiny.
Ngalak kaditj boodjar kep wer kaadidjiny kalyakool yoodaniny, wer koora wer yeyi ngalak Birdiya koota-djinanginy.

City of Cockburn acknowledges the Nyungar people of Beeliar boodja. Long ago, now and in the future they care for Country.
We acknowledge a continuing connection to land, waters and culture and pay our respects to the Elders, past and present.