Volunteer Form

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 PASSPORT 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

Two Referees required

NOT RELATED TO YOU
I have notified my Referees and I consent to Rise and Shine 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*

Do you speak fluent French

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

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 zoe@riseandshine.ie
Registration Name
Place of Work
Qualifications
Please select the following.

RGNRNIDPediatricMental HealthOther
Further information
Pin Number
Expiry Date
As Group Nurse I have read the Code of Practice, Safeguarding Policy and the Protocol for Group Nurse for Rise and Shine (all available on www.riseandshine.ie) 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 Rise and Shine, if any incident or occurrence arises or is brought to my notice, between completion of this form and my participation in Rise and Shine activities, concerning matters referred to in this section. I undertake to provide any further relevant information and advise Rise and Shine 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, Email info@riseandshine.ie As Rise and Shine 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 Code of Practice and the Safeguarding Policy (available on www.riseandshine.ie) 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 Rise and Shine.*

I understand
I will not use or bring any illegal substance on Rise and Shine activities. 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 Rise and Shine on these matters.*

I agree
I understand that my image may be contained and used in photographic and video material published by Rise and Shine 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 Rise and Shine 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 Kilcuan.*

I agree
The information may be disclosed to our 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
Signature

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Volunteer Form

Passport and EHIC/GHIC Section

MEDICAL SECTION

Group Nurse Section

Manual Handling Training Section

Safeguarding Section

General Section