House to Home Sign Up Form

House to Home Details

Which area would you like to volunteer on House to Home

House to Home volunteering dates in Belfast/Lisburn area are on Wednesdays and Thursdays. Please state if you have any preferred date/s

House to Home volunteering dates in the Ballymena area are on Thursdays and Fridays. Please state if you have any preferred date/s

Manager

Is this your first time volunteering with Habitat Ireland?

Personal Details

Salutation

Salutation - other

First Name

Surname

Date of Birth

Please note that volunteering on House to Home is for over 18's only

Mobile Phone

If you are under 18 years of age, please provide an email address of your parent/legal guardian?

Address

Town/City

Country

Country - other

County

Postcode/eircode

General Details

Occupation (if applicable)

Workplace/Place of study (if applicable)

Church/Parish Name (if regulary attend)

This question is optional and asked solely for church relations development

How did you hear about volunteering with Habitat?

Emergency Contact Information

Medical Details (Confidential)

Disclosure of your medical details does not necessarily prevent you from volunteering with Habitat. Any hospital or medical practitioner not having access to your medical history may need the information you provide. These details will be held securely in line with our privacy policy, kept confidential and only seen by appropriate Habitat Ireland staff.

Please detail any known medical conditions, allergies, special needs or requirements you have and if you have had any serious medical problems, illness or surgery in the last 3 years.

Any other relevant information that Habitat Ireland should be aware of to support you in your volunteering role?

Next of Kin

Name

Relationship

Main Contact Number

Declaration

Disclosure of details of any prosecutions or pending prosecutions does not necessarily prevent you from volunteering with Habitat. These details will be confidential and only seen by appropriate Habitat Ireland staff. The role may involve working alongside minors and vulnerable adults and we therefore need to ensure that you would be suitable for this role.

Do you have any convictions that are not "protected" as defined by the Rehabilitation of Offenders (Exceptions)(NI) Order 1979 as amended in 2014 Or The Spent Convictions and Certain Disclosures Act (ROI) 2016?

If the answer is Yes, we may need to discuss it with you. It will not necessarily prevent you from becoming a volunteer. If you wish, please give give further details below.

Data Protection

Habitat Ireland will hold the content of this application on file but will not release the information to any third party.Information will be used to process your application and provide volunteer management, communication and support. Further information can be found on our Privacy Policy

From time to time we would like to keep you updated about how your support is making a difference to our vital work on tackling poverty housing. Please specify your contact preferences below. You can change your preferences at any time, just email info@habitatireland.org or phone +44 2892 635635/+353 1531 0033

Marketing consent (select all that apply):

Contacted by emailContacted by postContacted by telephonePlease do not contact me

Photos/Videos

During the time you volunteer with Habitat, photographs/video may be taken for general Habitat Ireland promotional purposes to include internal and external publications and websites (eg Habitat Ireland website, Facebook etc). Habitat Ireland retain all rights, title and interest in such photography and media made.

Do you consent to Habitat Ireland using your photo, video, story or quote for promotional and media purposes?

YesNo

Thank you

Thank you for your willingness to volunteer with Habitat Ireland.

If you have any questions regarding volunteering, please email us at info@habitatireland.org or call us on +44 2892 635635

Contact Information