Volunteer Registration Form

Volunteer Registration Form
Volunteer Name

First NameMiddle NameLast Name
Birth Date

DayMonthYear
E-mail
example@example.com
Address*

Street Address

Address Line 2

CityState / Province

Postal Code
Phone Number

Area CodePhone Number
Mobile Phone
Emergency Contact (Name)
Emergency Contact (Relationship)
Emergency Contact Details

Address

Address Line 2

Town/CityState / Province

Postal Code
Emergency Contact Phone Number

Area CodePhone Number
Do you have any long-term conditions?

YesNo
If you have ticked "yes", please state condition(s) and whether you require additional support
Which volunteer roles are you interested in?

AdministrationBefriending (Including Phone Friends and Friendship Bubbles)Man CaveHelping in groupsShop AssistantFundraisingGardeningShoppingBreastfeedingTrusteeNot sure
Please tell us about any work, volunteering, personal experience or skills that you have that are relevant to the role you are interested in

At what times are you interested in volunteering – please tick as many as you like

References

To complete your application, we need you to supply us with two people who know you well enough to comment on your suitability for this role. They should not be family members. If you are not sure about who to put we are happy to discuss this with you
First Referee

Name

Address

AddressState / Province

Postal Code
Phone Number

Area CodePhone Number
Email
example@example.com
How does this person know you?
Second Referee

Name

Address

AddressState / Province

Postal Code
Phone Number

Area CodePhone Number
Email
example@example.com
How does this person know you?
If your volunteering role falls within the Rehabilitation of Offenders Act 1974 or is a specified or regulated activity, we will require you to have a DBS (Disclosure and Barring Service) check.

We welcome volunteer applications from every one. Having a criminal record will not necessarily exclude you from volunteering with us and your application will be dependent on the nature of the offence and position applied for.
Signature

Clear
Please sign with finger (tablet or phone) or mouse (computer)
Date

DayMonthYear
Date
How did you hear about us?

Volunteer CentreOur websiteFacebook/Twitter/InstagramOur leafletFriend or familyOther organisationOther websiteLocal paperWord of mouthOther
If "other", please give details below
Privacy Notice

At the Netherton Feelgood Factory, we’re committed to protecting and respecting your privacy. We have written a document (a Privacy Policy) that explains how we go about this. You can also find it on our website (www.feelgoodfactory.org.uk) or ask for a copy at the Feelgood Factory at any time.

The main points are below:

1.    We only collect information from you that we need to provide a good service.

For more information see sections 2 and 4 of the Privacy Policy.

2.    Some information from you we do require before you access services - this is usually to ensure your safety or to make sure that you are eligible under the terms of our funding - but you have the choice to decide if and how the Feelgood Factory contacts you.

For more information see section 6 of the Privacy Policy.

3.    We take care to make sure that any information we hold is kept secure.

For more information see section 8 of the Privacy Policy.

4.    We do not share information about you with anyone else without your express permission.

For more information see section 5 of the Privacy Policy.

5.    We will not keep information about you for longer than one year after you cease to be involved with the Feelgood Factory unless we are required to do so by law.

For more information see section 4 of the Privacy Policy.

6.    You have the right to request access to any data that the Feelgood Factory holds on you.

For more information see section 7 of the Privacy Policy.

7.    You have the right to request that information about you should be deleted or destroyed.

For more information see section 4 of the Privacy Policy.

If you need any more information please ask at reception, phone 0151 291 8010 or email info@feelgoodfactory.org.uk.
I consent to the information given by me in this form being recorded by the Netherton Feelgood Factory
We may need to contact you in connection with the service being offered to you (e.g. to tell you that a class has been cancelled). If you agree to us contacting you for this purpose please tick the relevant boxes.

PhoneTextEmailPost
We would like to contact you to let you know about new activities or developments in the Feelgood Factory that may be of interest to you. If you agree to us contacting you for this purpose please tick the relevant boxes.

PhoneTextEmailPost
I would like to Gift Aid
If I have ticked the box headed ‘Gift Aid? √’, I confirm that I am a UK Income or Capital Gains taxpayer. I have read this statement and want the charity or Community Amateur Sports Club (CASC) named above to reclaim tax on donations past, present or future. I understand that I must pay an amount of Income Tax and/or Capital Gains Tax in the tax year at least equal to the amount of tax that all the charities and CASCs I donate to, will reclaim on my gifts for that tax year. I understand that other taxes such as VAT and Council Tax do not qualify. I understand the charity will reclaim 25p of tax on every £1 that I have given
Should be Empty:

	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday (limited opportunities)
Morning
Afternoon
Evening (limited opportunities)

Volunteer Registration Form

References

If your volunteering role falls within the Rehabilitation of Offenders Act 1974 or is a specified or regulated activity, we will require you to have a DBS (Disclosure and Barring Service) check.