Healthwatch Northumberland volunteer registration of interest form

Thank you for your interest in volunteering for Healthwatch Northumberland!

To register your interest and receive more information, please complete this form. Everything you tell us will only be used for this purpose, will be treated in confidence, be stored securely and held in accordance with our retention schedule, after which time it will be securely destroyed. You can find our privacy policy on our website.

1. Your contact details: *

Full name	*
House number or name	*
Street	*
Town	*
Post code	*
Email address	*
Phone number	*

2. Date of birth *

	DD/MM/YYYY

3. Please tick the types of activities you are interested in helping us with then we can provide further details. Full support is provided. A Basic DBS check will be required for most roles (unless <18 yrs). For visiting care premises, an Enhanced DBS check would be necessary:

4. Some of our volunteer roles involve visiting premises and venues. Please tick the transport available to you:

Other (please specify)

5. How long are you interested in volunteering for?

Fixed time period only
Ongoing commitment
Not sure yet

Comment:

6. Approximately how much time can you give each month?

7. Please tell us why you would like to volunteer with us and what you hope to get from it yourself:

8. What skills, knowledge and experience do you have - from home and/or work life - that you would like to offer:

Please provide further details below:

9. What personal qualities do you have?

Other qualities, please write here:

10. Do you consider yourself to have a disability? If you tell us that you have a disability, we can make reasonable adjustments to assist you in your application or with our recruitment process. We will contact you to talk about this.

Yes
No
Prefer not to say

Comment:

11. Where did you hear about our volunteer programme?

12. Please use this box to tell us about anything else relevant to your application, including any employment or volunteering experience or any additional skills or life experiences you wish to share:

13. We’d like to keep you up to date with the work we’re doing, the results we’ve had and what people have told us about their experiences of health and social care through our monthly newsletter. Please read our Healthwatch Northumberland Privacy Policy (this will open in a new window) and indicate below to confirm if you would prefer not to receive this, or would like to receive a paper copy or an email copy of the newsletter sent to the postal/email address you already provided above. We won’t share your details with anyone else and we won’t email you too often.

*

I do not wish to receive the Healthwatch Northumberland monthly newsletter
I wish to receive a PAPER COPY of the Healthwatch Northumberland newsletter and have read, understood and accept the terms of the privacy policy.
I wish to receive an EMAIL COPY of the Healthwatch Northumberland newsletter and have read, understood and accept the terms of the privacy policy.

Volunteers are required to undertake a Disclosure and Barring Service check. This is free of charge for volunteers (any costs are reimbursed). The level of check will depend on the nature of the volunteer role. You can find our volunteering policy on our website.