Keyworker/Support Worker (only if you have one):
Emergency Contact Details:
What is your employment status?
Do you give St Werburghs City Farm permission to take photographs or videos of you with the intention to use in publicity materials, social media sites, website, reporting to funders, newspapers and magazine articles? Images will not be given to third parties.
By submitting this form I declare that the statements made and information given in this document are true and to the best of my knowledge and belief.
I agree that such enquiries as may be considered may be made to the police or any other person or organisations.
I understand that the police will disclose any cautions or convictions for the purposes of this application only.
Also by submitting this form, you are giving us you give us permission to contact you about Farm volunteering opportunities and events. In order to comply with the General Data Protection Regulation, St Werburghs City Farm is seeking your consent to hold your information on our database. We are required by our funders to gather information about the people who use our services. We will not share your information with third parties other than those you have agreed to. We use and store any information that you give us in accordance with the Data Protection Act 2003. Information you provide will be anonymised before being used in monitoring and evaluation reports for our current funders, to support funding applications. Your data will be held for a maximum of 2 year after your last engagement. Further details on our data protection and information sharing policies are available from St Werburghs City Farm. If you have any queries about the data we hold, please do get in touch by calling 0117 9428241 or emailing us at email@example.com.