Keynsham & District Mencap Society Volunteer Application Form
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Mr/Mrs/Miss/Other:
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Surname:
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Forenames:
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Date of Birth:
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Address:
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Tel No:
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Mob:
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Email:
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Occupation:
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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?
If yes please state:
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Why would you like to become a Keynsham Mencap Volunteer?
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What do you hope to achieve from your volunteering experience?
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Please outline what skills/experiences/interests you have to offer the volunteering role:
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Which of the Keynsham & District Mencap Clubs would you like to volunteer for?
How did you hear about the volunteering roles at Keynsham Mencap?
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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:
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Please give details of any medical conditions:
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Do you have any allergies?
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Are you taking any regular medication?
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Emergency contact name and number
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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:
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Relation:
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Address:
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Telephone Number:
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Email:
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Mr/Mrs/Miss/Other
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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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