Volunteer Form

Volunteer Form

The Irish Pilgrimage Trust, Kilcuan, Clarinbridge, Co. Galway H91 W596 PH 00 353 91 796622 info@irishpilgrimagetrust.com Charity Reg No 20009953 Rev No CHY5992
Our Online Volunteer Form is for over 18 Volunteers only, if you are under 18 please contact our office on 00 353 91 796622.

Thank you
Title
Name*

First NameLast Name
Gender
Group Number or Group Leader's Name
Are you volunteering with

Lourdes EasterHosanna HouseFriendship Week
Date of Birth*

DayMonthYear
Date
Email*
example@example.com
Address Line 1*

Address Line 2

Address Line 3

CityCounty

Postal / Eir Code
Mobile Number*

Area CodePhone Number
Next of Kin Name *
Next of Kin Contact Number*
You will need your PASSPORT and EHIC/GHIC for LOURDES and HOSANNA HOUSE only, you do not need a PASSPORT or EHIC/GHIC for FRIENDSHIP WEEK in Kilcuan.

Your data will be stored securely and will be processed in accordance with the Data Protection Acts 1988, 2003, 2018 alongside GDPR legisiation.

Passport and EHIC/GHIC Section

You will need your PASSPORT and EHIC/GHIC for LOURDES and HOSANNA HOUSE only, you do not need a PASSPORT or EHIC/GHIC for FRIENDSHIP WEEK in Kilcuan.
Name on Passport
Passport Number
Place of Birth (as shown on your passport)
Passport Expiry Date

DayMonthYear
Date
Upload title page (PHOTO PAGE) of your passport
THE NAME ON THE PASSPOST MUST BE THE SAME AS THE NAME ON THE EHIC/GHIC CARD.
EHIC Number/GHIC Number(NI)
EHIC/GHIC(NI) Expiry Date

DayMonthYear
Date
Upload a copy your EHIC/GHIC card
Upload your EHIC/GHIC card

Cancelof

Have you volunteered with the Irish Pilgrimage Trust previously?

YesNo
If YES, What is the Group Number and/or Year
Do you speak fluent French

YesNo
What Level?
Do you have skills that could be of benefit to the Trust (e.g. PR, Social Media, Sound Engineer, Musician etc)
What is your Profession?

Two Referees required

NOT RELATED TO YOU
I have notified my Referees and I consent to The Irish Pilgrimage Trust contacting the following two referees for my character reference.

I agree
First Referee Name*
First Referee Address*
First Referee Email Address*
First Referee Mobile Number*
Second Referee Name*
Second Referee Address*
Second Referee Email Address*
Second Referee Mobile Number*

Are you the Group Nurse for your group?

NOYES
Are you the Group Nurse for your Group?

YesNo

Group Nurse Section

Please send your Current Nursing and Midwifery Board of Ireland renewal Letter or Current Cert UK CC renewal to zodea@irishpilgrimagetrust.com
Registration Name
Place of Work
Qualifications
Pin Number
Expiry Date
As Group Nurse I have read the Code of Practice, Safeguarding Policy and the Protocol for Group Nurse for The Irish Pilgrimage Trust (all available on www.irishpilgrimagetrust.com) and I agree to adhere to them.

YESNO

Manual Handling Training Section
Have you completed a Manual Handling Training in the last 3 Years?

YesNo
If yes, please state the Trainer/Company?
If yes, what Year did you complete your Training?
Have you completed People Moving and Handling

YesNo
If yes, please state the Trainer/Company?
If yes, what Year did you complete your Training?

Safeguarding Section

The following Information is required for Safeguarding.
Have you ever been or are you currently, the subject of any investigation, complaint or disciplinary procedure, caution or awaiting the outcome of any pending prosecution?*

YesNo
Have you ever been convicted of a criminal offence or been subject to caution or bind over against an individual of individuals?*

YesNo
Has an order ever been made against you in respect of a child in your care, which has been found to be in need of care, protection or control?*

YesNo
I undertake to advise The Trust, if any incident or occurrence arises or is brought to my notice, between completion of this form and my participation in the Trust activities, concerning matters referred to in this section. I undertake to provide any further relevant information and advise The Irish Pilgrimage Trust of any changes after completing this form.*

I agree

General Section

Please contact the office in relation to current fares/cost for Easter Pilgrimage, Hosanna House and Friendship Week in Kilcuan/Cois Cuain, Email info@irishpilgrimagtrust.com. As the Trust is dependent of fundraising and donations to continue its work, each carer is asked to help fundraising with their Group.
I have read and understood the Trust's Code of Practice and the Safeguarding Policy (available on www.irishpilgrimagetrust.com) and I am suitable in every way to perform the work and duties of a volunteer/carer.*

YesNo
I understand and accept that I am required to complete training to act as a Carer with The Irish Pilgrimage Trust.*

I understand
I will not use or bring any illegal substance on The Irish Pilgrimage Trust activities/pilgrimages. I agree not to be under the influence of alcohol or any other substance which might reduce the standards of care and behaviour required. I agree to comply with directions received from The Irish Pilgrimage Trust on these matters.*

I agree
I understand that my image may be contained and used in photographic and video material published by the Trust in all its promotional publications including hardcopy, electronic and internet and hereby give consent to such use.*

I agree
The Information provided on this Volunteer form may be used by The Irish Pilgrimage Trust to assist the Trustees/Group Leaders in deciding who best to nominate/choose as a carer on the Easter Pilgrimage, Hosanna House and/or Friendship Weeks in Cois Cuain / Kilcuan.*

I agree
The information may be disclosed to The Trust Medical Doctor, Trustee and Group Leader. You, as the provider of the information and entitled to a copy of your information on request under section 15 of GDPR legislation. You, as the provider of the information are entitled to rectify, and/or remove the information where possible if inaccurate or processed unfairly.*

I understand
Volunteer Signature  First NameLast Name   Signature
Parent or Guardian must sign below if the volunteer is under 18 years of age.
First Name   Last Name   Signature
If Guardian please specify under what authority
Type a label
Should be Empty:

Volunteer Form

Passport and EHIC/GHIC Section

MEDICAL SECTION

Group Nurse Section

Manual Handling Training Section

Safeguarding Section

General Section