Membership Application

If you are a nonprofit organisation working in the Cape Winelands and you would like to become a Valcare member in 2019, please complete the form below.
For more information on what Valcare membership entails, the costs and the benefits, please click here.

Please note that if you are an Early Childhood Development Centre (ECD), you will have to register with Inceba Trust for membership which will automatically grant you access to Valcare benefits. If you are an ECD, please contact 083 321 7562 or email nb@incebatrust.co.za.

Organisation Details

Name of organisation *

Office number *

General E-mail *

Facebook page address

Website

Brief overview of your organisation [100 words] *
List other programmes or projects within your organisation [100 words] *

Current number of paid staff members at your organisation *

Number of volunteers that are involved with your organisation *

Primary contact

First Name *

Last Name *

Job title *

Cellphone no *

E-mail *

Communication / Alternative contact

First Name *

Last Name *

Job title *

Cellphone No *

E-mail *

Physical Address

Building/house number *

Street name *

Suburb *

City *

Postal Address

Same as Physical Address?
YesNo

Building

Street name/ PO Box

Suburb

City

Focus Areas

Please specify your focus area/s

Recreational activitiesVulnerable peopleHealthFood securityEducation support

Clean, safe and attractive environment
Community safetyAttractive spacesCommunity facilitiesShelterInfrastructure

Productive society with economic opportunities
Enterprise developmentTechnologyLeadership and mentorshipSkills developmentJob placement

Social Cohesion
Community mobilisationFamily relationshipsInter culture relationships

Please Specify Other

Registration information

Is your organisation registered?
YesNo

Is your organisation registered as an NPO?
YesNo

Registation number
Date of registration

Is your organisation registered as an NPC?
YesNo

Registation number
Date of registration

Is your organisation registered as a Trust?
YesNo

Registation number
Date of registration

Is your organisation registered as a Partial Care Facility?
YesNo

Registation number
Date of registration

Other type of registration
YesNo

Please Specify
Registation number
Date of registration

Project information

Project location/s *
FranschhoekGouda/Saron/HermonKlapmutsMbekweniSimondiumStellenboschWellingtonPaarlPaarl-EastOther

Specify Other Project location

Do you hand out food?
YesNo

What time of year?
WinterSummerWhole year
What days?
MondaysTuesdaysWednesdaysThursdaysFridaysSaturdaysSundaysOnly when available
What type of meal?
BreakfastLunchDinnerSnacksOther

Number of beneficiaries per age group
Children 0-5
Children 6-12
Children 13-18
Young Adults 19 - 25
Young Adults 26-35
Adults 35-59
Elderly 60+
Total number of beneficaries

Can you confirm that 75% of your beneficiaries are individuals who meet the definition Black as defined in terms of the Department of Trade and Industry's Broad-based Black Economic Empowerment(B-BEE) Codes of Good Practice
YesNo

Resources Available

Please indicate what resources you have to offer or make available to other Valcare Members
Peer trainingVenueFacilitiesPreferred service providers
Please specify

Please note the following documents need to accompany your application form: Registration documents, Constitution
- The following file types are allowed: pdf, jpg, bmp, png, doc, docx, xls, xlsx.
- Maximum size per file: 5MB.

Registration documents *

Constitution documents *

We give permission to Valcare to send us relevant communication via email and SMS. *YesNo

* Required fields.