Membership Application 2020

Early Childhood Development Centres:

Please note that if you are an Early Childhood Development Centre (ECD), you will have to register to become a member of our ECD Partner, Inceba Trust by clicking here. Your Inceba Membership will grant you access to Valcare benefits.

Saving this Form:

Please note that this form can't be saved and will need to be completed and submitted in one go. To ensure a quick and seamless process, we recommend that you check and prepare all required information and documentation before commencing. It will take about 10 minutes to complete.

Name of organisation *

Office number *

General Organisation E-mail *

Facebook page address

Website

Brief overview of your organisation [250 words] *

List other programmes or projects within your organisation [250 words] *

Current number of paid staff members at your organisation *
01-56+

Number of volunteers that are involved with your organisation *
01-56-1011-2020+

First Name *

Last Name *

Job title *

Cellphone no *

E-mail *

First Name *

Last Name *

Job title *

Cellphone No *

E-mail *

Building/house number *

Street name *

Suburb *

City *

Same as Physical Address?
YesNo

Is your organisation registered?
YesNo

Please choose the categories that would best describe your programme or project:

A. Primary beneficiary your organisation reaches. (select multiple)
Youth (18-35)Vulnerable Children (0-18)Older Persons (65+)Persons with DisabilitiesVulnerable WomenChildren and FamiliesPrisoners and Ex-OffendersHomeless PeopleNonProfit Organisations
Please Specify Other

B. Primary service your organisation provides.
Skills Development and Job ReadinessTraining and Capacity Building for OrganisationsSport and RecreationEarly Childhood DevelopmentEducation SupportFood and Nutritional SupportSpiritual Care and Social Well-beingHealth CareCommunity Safe SpacesSocial Services and SupportCommunity Engagement and Advocacy
Please Specify Other

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

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

Do you hand out food?
YesNo

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

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

Please note that your registration documents and constitution need to accompany your application form.
If you submitted these documents for the 2019 membership year, and they haven’t changed, you don’t have to do upload them again.
- The following file types are allowed: pdf, jpg, bmp, png, doc, docx, xls, xlsx.
- Maximum size per file: 5MB.

Registration documents:

Constitution documents: