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Keynsham & District Mencap Society Volunteer Application Form
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Email
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Your email
Application Date:
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DD
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YYYY
Mr/Mrs/Miss/Other:
Your answer
Surname:
Your answer
Forenames:
Your answer
Date of Birth:
MM
/
DD
/
YYYY
Address:
Your answer
Tel No:
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Mob:
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Email:
Your answer
Occupation:
Your answer
Please answer the following questions to give us some information about you. Don’t worry if you don’t know what to write here. Leave a section blank if you are unsure.
Do you have any professional/personal experience of people with learning disabilities?
Yes
No
Clear selection
If yes please state:
Your answer
Why would you like to become a Keynsham Mencap Volunteer?
Your answer
What do you hope to achieve from your volunteering experience?
Your answer
Please outline what skills/experiences/interests you have to offer the volunteering role:
Your answer
Which of the Keynsham & District Mencap Clubs would you like to volunteer for?
Club25
Go Explore
Music Man Project
SENSations Under 11
SENSations Over 11
Saturday Club
Fitness Club
Football Club
Boccia Club
How did you hear about the volunteering roles at Keynsham Mencap?
Your answer
The following questions are about you and your well-being, relating to health and safety and who we should contact for you in an emergency. This information is kept private and it will only be used or shared in an emergency
Do you consider yourself to have a disability? If yes, please give details:
Your answer
Please give details of any medical conditions:
Your answer
Do you have any allergies?
Your answer
Emergency contact name and number
Your answer
As a volunteer with Keynsham & District Mencap Society you will be expected to complete an enhanced DBS application (Disclosure Barring and Service. This checks your criminal records and your suitability to work with vulnerable people). You must inform us if anything changes which may affect your DBS Certificate, or any changes to your personal circumstances which may affect your suitability to volunteer.
References
Please use the space below to provide details of two references
Mr/Mrs/Miss/Other
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Name:
Your answer
Relation:
Your answer
Address:
Your answer
Telephone Number:
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Email:
Your answer
Mr/Mrs/Miss/Other
Your answer
Name:
Your answer
Relation:
Your answer
Address:
Your answer
Telephone Number:
Your answer
Email:
Your answer
Thank you for completing this form.
When your form is submitted it will be sent by email to: Laura Jefferies, Keynsham Mencap Society Operations Manager who will be in touch with you shortly.
A copy of your responses will be emailed to the address you provided.
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