Volunteer application form | St. Michael's Hospice

Current Your personal information
Roles & Experience
Volunteering for us
References
Protecting Your Information & Keeping you informed
Secondary Education
Complete

Your Personal Information

Prefix

First name

Last name

Date of birth

Your email address

Address Line 1

City

County

Post Code

Country

Your phone number

Do you hold a current full UK driving licence?

Yes

Have you suffered any bereavement within the last 2 years?

Yes

Do you have any medical conditions that we should be aware of?

Yes

(Volunteers are not required to complete a medical form but we ask that you provide any relevant Information)

Emergency Contact Name*

Emergency contact first name

Emergency contact last name

Relationship to you

Emergency Contact Phone number

I have read and understand the Criminal Records Disclosure.

Due to the nature of our work, some of our Hospice volunteer roles require you to undertake a criminal record check via the Disclosure & Barring Service. We are exempt from the Rehabilitation of Offenders Act1974, and you are required to declare all criminal convictions whether they are 'spent'. Your declaration will be treated in strict confidence and will be considered only in relation to this application. Please provide any details on a supplementary sheet and attach to this form.

Parent/carer first name

Parent/carer last name

Parent/carer relationship to you

Parent/carer email

Your school

Duke of Edinburgh level

Dates of Work Experience Placement Required