2015 Conference Volunteer Registration

Volunteer Registration
Name*

First NameLast Name
Date of birth*

MonthDayYear
Date
E-mail*
Phone Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How did you hear about Intouch Foundation? (You may select more than one)*

Friend or family memberSocial mediaInTouch Foundation websiteVolunteering platformOther
When are you available to volunteer? (You may select more than one)*

Weekday – DaytimeWeekday – EveningWeekend – DaytimeWeekend – Evening
Why do you want to become a volunteer with Intouch Foundation?*
What skills and attributes would you bring to the InTouch Foundation?*
Do you have any health conditions that may affect volunteering?*

YesNo
Do you drive?*

YesNo
Do you have a minibus licence (D1)?

YesNo
Do you have any criminal conviction/s? (A DBS check will need to be done if you cannot provide a CRB) *Having a criminal conviction does not necessary mean you cannot volunteer*

YesNo
Agreement

1. Not to disclose any information about InTouch Foundation to any third person or agency without permission from the CEO or Management Committee.
2. Not to use any contacts or information gained through work done for the InTouch Foundation for personal gain.
3. I will not bring InTouch Foundation into disrepute by my actions.

Photo/Video Authorisation:
I authorise you to take photographs/video of me and for those images to be used by InTouch Foundation for the purpose of printed, digital, video or other mediums, for the purposes of promotion and publicity for InTouch. Those images shall be the property of InTouch Foundation for any and all use.
Seated position*

I agree to follow InTouch Foundation’s volunteer code of conduct.I authorise use of photos/videos for publicity purposes.
Date*

MonthDayYear
Digital signature*

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