APPLICATION FORM FOR A NEW VOLUNTEER AT A MEMBER GROUP
East Liverpool RDA
Charity NO: 1175033
Natalie Burns
Riderscroft L35 6NW
EastLiverpoolRDA@gmail.com
07985364655
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Email *
YOUR DETAILS
Full Name *
First and last name
Date of Birth *
Address *
Gender *
Age *
Phone number *
Mobile Number
SPECIFIC INFORMATION ABOUT YOU
The information in this section will be used to help us learn a little more about you, understand your needs, and ensure we are able to place you in a suitable volunteering role in the group.
Equine Experience *
Experience volunteering/working with people with disabilities *
Other skills and professional qualifications *
Do you consider yourself disabled? *
Is there any information that we may need to consider when placing you as a volunteer to ensure you have a positive experience? (Medical conditions, impairments, specific needs, accessibility requirements,allergies, etc.) *
EMERGENCY CONTACT DETAILS
If you become a volunteer with us it's important we know who to contact in case you are injured or become ill while volunteering.
Full Name *
Relationship to you *
Telephone Number *
Consent *
REFERENCES
We request all volunteers provide two references to support their application. These people should not be related to you, should have known you for at least 2 years and should be someone you know in a professional capacity where possible.
It is our policy to take up all references.
Reference 1
Full Name *
Address *
Email *
Phone *
Reference 2
Full Name *
Address *
Email *
Phone *
DECLARATION
I consent to an enhanced disclosure check being made (if applicable), will abide by the group's policies and procedures and confirm that the information provided on this form is correct. I accept failure to disclose information or subsequent failure to conform to the group's Safeguarding Policies & Procedures may result in possible disciplinary action.

As part of the checking procedures, you are advised that the Group reserves the right to make reference to the Local Authority Social Services Department and Police Records to verify information given on this form, when it is submitted or at any time in the future.

NB: It is the duty of all Group personnel, coaches and volunteers to report any conviction involving children.
Consent *
Signature - Type Your Name *
Date *
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If you are under 18 this form must also be signed by a parent or guardian.
Signature - Type Your Name
Date
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YYYY
The information provided on this form will only be used for the purposes stated above in relation to RDA volunteering activities.
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