Thursday Volunteer Form
Name
*
Forename(s)
Surname
Gender
*
Date of Birth
*
/
Day
/
Month
Year
Date
Nationality
*
Address
*
Address
Street Address Line 2
Town
County
Post Code
Telephone
*
Email
*
example@example.com
Occupation
Next of Kin Details (Must be available to be contacted 24 hour)
Name
*
Relationship to you
*
Address
Address
Street Address Line 2
Town
County
Post Code
Next of Kin Telephone
*
Next of Kin Alternative Telephone
Next of Kin Email
*
example@example.com
Medical Information (or write 'none')
*
Medical conditions or disabilities need not prevent anybody from taking part in volunteering, however we need to be informed in advance of anything that may affect safety. Please provide details here of any illnesses, disabilities, conditions, allergies and medications (including name, dosage and frequency).
Dietary Information (or write 'none')
*
Do you consent to your photo being taken and potentially used in promotional material (social media, reports, etc)?
*
DECLARATION:
I confirm I have provided all relevant details of any medical, physical or other conditions which might affect the safety or wellbeing of myself or anyone I am volunteering with.
I consent to being given emergency medical treatment, including the administration of anaesthetic should it be necessary, and authorise Sailing Tectona staff to give such permission as may be necessary for such treatment to proceed.
I understand that the use and retention of my personal information will be in accordance with Sailing Tectona’s privacy policy.
I understand that if I fail to behave in an appropriate manner I may be asked to go home.
Signed
*
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