Volunteer Sign-up Form

Outside Lives Ltd Volunteer Form

Please note: all fields with a red asterisk (*) must be completed

Your Contact Information

Page 1 of 6
Name*

First NameLast Name
Date of Birth*

DayMonthYear
Date of Birth
Address*

Address Line 1

Address Line 2

Town/CityCounty

Post Code
Phone Number*
Please enter a valid phone number.Format: 00000-000-000.
A Different Phone Number
Please enter a valid phone number.Format: 00000-000-000.
Email*
example@example.com

Emergency Contact Information

Page 2 of 6
Emergency Contact 1 - Name*

First NameLast Name
Emergency Contact 1 - Phone Number*
Please enter a valid phone number.Format: 00000-000-000.
Emergency Contact 1 - Relationship to you*
Emergency Contact 2 - Name*

First NameLast Name
Emergency Contact 2 - Phone Number*
Please enter a valid phone number.Format: 00000-000-000.
Emergency Contact 2 - Relationship to you*

Medical Information

Page 4 of 6
Do you have any allergies?*

Yes (please specify)No
Yes*
Do you have any health conditions we need to be made aware of?*

Yes (please specify)No
Yes*
Do you have any access or support requirements?*

Yes (please specify)No
Yes*
If you are injured or become unwell while volunteering do you give consent to receive first aid from a qualified person?*

YesNo
Please Note: In accordance with the Mental Health Capacity Act (2005) Outside Lives will assume that people have the capacity to make their own decisions whilst engaging with us. Should we have proof that a person lacks the capacity to make specific decisions, we will seek to identify an appropriate individual (within their personal networks) to support them.

Checks

Page 5 of 6
Do you have a criminal record or do you have any pending criminal prosecutions?*

YesNo
If you wish to specify please do so here
Please note: Depending on the type of volunteering you become involved with we may need to complete a DBS check and / or seek references to confirm any existence of criminal convictions / to get confirmation of character or experience. We will inform and obtain your consent for this if they are required

Confirmation

Page 6 of 6
Where did you hear about us?
Please specify here*
What is your level of Welsh Speaking?

NoneBasicModerateComfortableFluent
*

I declare that, to the best of my knowledge, the information I have provided in this application form is true and accurate. I understand that if it is subsequently discovered that any statement is false or misleading, my voluntary position may be terminated without notice.
Should be Empty:

Outside Lives Ltd Volunteer Form