Volunteer registration

First Name *

Last Name *

Date of Birth *

Your Email Address *

Address *

Preferred Contact Telephone Number *

Present occupation/Status *

In case of emergency, please contact *

Emergency contact telephone number *

Relationship to this person: *

Why would you like to be a volunteer? *

Have you undertaken voluntary work before? *

If yes, please give brief details

Do you have particular skills, hobbies or interests you might be able to use a volunteer *

If selected other, please give details

If yes, please give details of offences, penalties and dates below

Text field

Please give the name and contact details, including email, of TWO adults whom we may, if required, contact as referees, one of which must be a current or previous employer or someone in a professional capacity who has known you for at least 3 years

Referee 1

Referee Telephone number

Referee Email address

Referee 2

Referee Telephone number

Email address

General Data Protection Regulation. I am aware that certain personal information may be collected and stored in connection with my volunteer role and give my consent to Blesma to hold this whilst undertaking volunteer work with them. *

General Data Protection Regulation. I am aware that certain personal information may be collected and stored in connection with my volunteer role and give my consent to Blesma to hold this whilst undertaking volunteer work with them.

I am not aware that my past or current mental or physical health status would make voluntary work detrimental to me or adversely affect any person or persons with whom I may come into contact. *

I am not aware that my past or current mental or physical health status would make voluntary work detrimental to me or adversely affect any person or persons with whom I may come into contact.

I agree that the information provided in this form is correct to the best of my knowledge. *

I agree that the information provided in this form is correct to the best of my knowledge.

During the course of your volunteering activity, you may have access to, see or hear information of a confidential nature. You are expected to use your discretion and maintain confidentiality about information relating to all aspects of your volunteering activity. Disclosures of information relating to Association Members, members of staff, other volunteers or that which you acquire during the course of your volunteering activity may only be disclosed with the agreement of the Blesma National Volunteer Officer. You are reminded that a breach of confidentiality is liable to result in your volunteering role being terminated. Moreover, the Data Protection Act 1998 also renders an individual liable for prosecution in the event of unauthorised disclosure of information, or action for civil damages under the same Act. I have received, read and understood the Blesma Statement of Confidentiality. *

020 8590 1124

Volunteer Registration Form

Your comment

We can help