Forms

This page brings together the forms we use to support Coolamon Landcare’s day‑to‑day activities. Whether you’re signing in at a working bee, reporting an incident, requesting reimbursement, or submitting an enquiry, you’ll find the right form below.

This list is rapidly growing and each section can be expanded to show the form when you need it.

Conflict of Interest Disclosure Form

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Your Details

Name *

First

Last

Email *

Your Role / Position *— Select Choice —Committee MemberGeneral MemberVolunteerProject LeadContractor / ConsultantOther

Your role (if other) *

Conflict of Interest Declaration

Date of Declaration *

Do you have one or more Conflicts of Interest to report? *

• Yes, 1
• Yes, more than 1
• No

Conflict of Interest #1

Type of Conflict *

• Actual Conflict
• Potential Conflict
• Peceived Conflict

Related Person or Organisation

Name of the person, business, or organisation involved (if applicable).

Description of the Conflict *

Please describe the nature of the conflict, including any personal, financial, or organisational interests involved.

Conflict of Interest #2

Type of Conflict *

• Actual Conflict
• Potential Conflict
• Peceived Conflict

Related Person or Organisation

Name of the person, business, or organisation involved (if applicable).

Description of the Conflict *

Please describe the nature of the conflict, including any personal, financial, or organisational interests involved.

Do you have another Conflict of Interest to report? *

• Yes
• No

Conflict of Interest #3

Type of Conflict *

• Actual Conflict
• Potential Conflict
• Peceived Conflict

Related Person or Organisation

Name of the person, business, or organisation involved (if applicable).

Description of the Conflict *

Please describe the nature of the conflict, including any personal, financial, or organisational interests involved.

Do you have another Conflict of Interest to report? *

• Yes
• No

Conflict of Interest #4

Type of Conflict *

• Actual Conflict
• Potential Conflict
• Peceived Conflict

Related Person or Organisation

Name of the person, business, or organisation involved (if applicable).

Description of the Conflict *

Please describe the nature of the conflict, including any personal, financial, or organisational interests involved.

Do you have another Conflict of Interest to report? *

• Yes
• No

of Interest Interest

Conflict of Interest #4

Type of Conflict *

• Actual Conflict
• Potential Conflict
• Peceived Conflict

Related Person or Organisation

Name of the person, business, or organisation involved (if applicable).

Description of the Conflict *

Please describe the nature of the conflict, including any personal, financial, or organisational interests involved.

Do you have another Conflict of Interest to report? *

• Yes
• No

Additional Conflicts of Interest *

This form allows a maximum of 5 Conflicts of Interest to be submitted. Please list any additional Conflicts of Interest in this box, alternately, you can re-submit another form to capture the details or email the details to coi@coolamonlandcare.org.au.

Supporting Documents

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3

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For quotes, correspondence, or other relevant material (optional).

Confirmation Checkbox *

• I declare that the information provided is true and complete to the best of my knowledge, and I agree to comply with Coolamon Landcare’s Conflicts of Interest Policy.

Signature *

Clear Signature

Leave this field empty

Submit

Incident / Near-Miss Report Form

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Reporter Details

Reporter Name *

First

Last

Reporter Phone *

Reporter Email *

Incident Details

Person Involved in Incident *

First

Last

Date / Time of Incident *

Date

Time

Location of Incident

Location

Type of ReportSelectIncidentNear-MissHazardObservation

Description of What Happened *

Injuries Sustained (if any)

First Aid Provided? *

• Yes
• No

Witness Names & Contact Details

Actions Taken

Do you require follow-up? *

• Yes
• No

Photos / Uploads

Camera Capture With Your Camera

Camera Preview

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3

Use Photo Apply Crop

Provided? of Do

File Upload

Drag & Drop Files, Choose Files to Upload

Leave this field empty

Submit

Contact Form

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Name *

First

Last

Email *

Would Join other,

Phone

What's your enquiry about? *— Select Choice —Volunteering / MembershipEventsNative PlantsLocal WildlifeLandcare ProjectsMedia / CommunicationsOther

If other, what's your enquiry about? *

Comment or Message

Would you like to Join our mailing list?

• Keep me updated about local projects, events, and opportunities.

Leave this field empty

Submit

Membership Form

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Membership Details

Is this a new membership or a renewal? *

• New Membership
• Renewal
• Other

Membership Type *

• Individual
• Family

Information on our fee structure & eligibility can be found in our Membership & Fees Policy.

How many adults are included in this family membership? *

• One
• Two

Are any children included in this family membership? *

• Yes
• No

Please note, children (dependents under 18) must reside at the same residential address as the adult/s under the family membership. For more info, please see our Membership & Fees Policy.

Member Information

Adult Adult many

Adult Member Information

Adult Member #1 Information

Name *

First

Last

Preferred Communication *

• Email
• Text Message
• Phone Call

Contact Email *

Contact Phone *

Emergency Contact Details

Name *

First

Last

Relationship to Member *

Emergency Phone *

Adult Member #2 Information

Name *

First

Last

Preferred Communication *

• Email
• Text Message
• Phone Call

Contact Email *

Contact Phone *

Children Information

Name *

General Membership Questions

Interests and Hobbies *

Reasons for Joining Coolamon Landcare Group *

Referred By (if applicable)

First

Last

Confirmation

Agreement *

• I have read and agree to Coolamon Landcare Group’s Legal & Governance Documents.

Signature *

Clear Signature

Application Date *

Total

$0.00

Payment Method *

• Online (Now)
• In Person

Square *

Card

Name on Card

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