Online Volunteer Interest Form Don't worry: all information you give is confidential and intended solely for St Werburghs City Farm! Volunteer Interest Form Contact Details: Name * Email * Telephone Number * Address * Day of Birth * 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month * January February March April May June July August September October November December Year * 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Keyworker/Support Worker (only if you have one): Name Organisation Email Contact Number Emergency Contact Details: Name * Relationship * Email * Contact Number * Questionnaire: Why do you want to volunteer at St Werburghs City Farm? * Which times / days are you available to volunteer? * How long would you like to be involved in the project for? * How did you hear about the Farm's volunteering / training opportunities? * What is your employment status? * Student Unemployed Employed Retired Other (if so, please specify in following box) Health Do you consider yourself to be affected by a mental or emotional condition? * Do you consider yourself to have a learning difficulty? * Do you consider yourself to have a physical health issue, including any allergies, food intolerances or dietary requirements? * Do you have a current/recent problematic drug/alcohol use issue? * Additional Support * Equal Opportunities: Please describe your ethnicity Please describe your gender Please describe your sexual orientation Photo Consent: 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. * Yes No Would you like to sign up to our newsletter? Yes No Declaration: 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 office@swcityfarm.co.uk. reCAPTCHA If you are human, leave this field blank. Submit