Volunteer Information Form

First name

This should be your legal name

Last name:

Known as

Please let us know if you are known by a different first name

Address 1:

Address 2:

Town/City:

Postcode:

Reference first name:

Reference last name:

Reference email:

Reference telephone number

With no spaces

Relationship to you:

Reference #1:

Reference first name:

Reference last name:

Reference email:

Reference telephone

With no spaces

Relationship to you:

Reference #2:

Emergency contact first name:

Emergency contact last name:

Emergency contact telephone:

With no spaces

Relationship to you:

Do you have any medical conditions, disabilities or additional support needs we should be aware of, or do you require any adjustments to enable you to carry out your volunteer duties?

YesNo

If yes, please provide more information

Has someone you had a close connection to died in the past year?

Please provide any additional Information that you feel is relevant to your volunteer application.

I, being eighteen (18) years of age or over, hereby grant permission to Garden House Hospice Care, to interview, photograph, and/or videotape me; and/or to supervise any others who may do the interview, photography, and/or videotaping; and/or to use and/or permit others to use information from the aforementioned interview and/or the aforementioned images in promotional activities including social networking without compensation.

YesNo

As a volunteer, it is a part of your role to receive emails from the Volunteer Engagement Team to ensure you are kept up to date with volunteering at Garden House Hospice Care. These will not exceed one per week. If you would also like to receive emails from the fundraising team about events, campaigns and news relating to fundraising for Garden House Hospice Care, please select below:

YesNo