SEND Volunteer Starter Form

Your Details

Salut.

First Name

Last Name

Phone No.

Address Line 1

Address Line 2

Town

Postcode

Is there anything about yourself that you would like us to know in relation to your role with us (e.g. access needs, disability, health issues etc)?

Yes

Please tell us more about this and how we can support your needs

Emergency Contact Details

Please give details of who we should contact in an emergency

Salutation

First Name

Last Name

Phone/Mobile

Relationship to You

Alternative Contact Number

Support Worker Details

Please give details of your Support Worker

Salutation

First Name

Last Name

Organisation Name

Phone/Mobile

Office Phone Number

I have read and agree to the Terms and Conditions and Volunteer Privacy Policy

Volunteer Equality and Diversity Monitoring

Please take a few moments to complete our Equality and Diversity Monitoring Form.

We believe achieving equality, diversity and fairness of opportunity is our shared responsibility and we work hard to ensure that as an organisation, we are all accountable for its delivery.

In order to assist us to monitor and evaluate the delivery of our vision we would appreciate it if you will complete this monitoring form. All questions have a 'prefer not to say' option.

The other information provided will be used for statistical purposes only. Statistical data provided to external organisations is anonymised.

Statistical data is critical for us when applying for grants.

We Are BS15 is committed to protecting the privacy and security of your personal data. For further information please refer to our Privacy Notice which can be viewed here: wearebs15.co.uk/privacy-policy/

If you prefer to use your own term, please write it here:

Is the gender you identify with the same as your gender registered at birth?

Yes

Prefer not to say

Ethnicity

Ethnic origin is not about nationality, place of birth or citizenship. It is about the group to which you perceive you belong.

Please tick the appropriate box.

White

English/Welsh/Scottish/Northern Irish/British

Irish

Gypsy or Irish Traveller

Any other White background, please describe

Any other white background, please write here

Mixed / Multiple Ethnic Backgrounds

White and Black Caribbean

White and Black African

White and Asian

Any other Mixed/Multiple ethnic background, please describe

Any other mixed background, please write here

Any other Asian background, please write here

Black / African / Caribbean / Black British

African

Caribbean

Any other Black/African/Caribbean background, please describe

Any other Black/African/Caribbean background, please write here

Other ethnic group

Arab

Any other ethnic group, please describe

Any other ethnic group, please write here

Prefer not to say

Disabilities

The Equality Act 2010 defines a person as disabled if they have a physical or mental impairment, which has a substantial and long-term (i.e. has lasted or is expected to last at least 12 months) adverse effect on the person’s ability to carry out normal day-to-day activities.

Do you consider yourself to have a disbility or health condition?

Yes

Prefer not to say

Please indicate your disability (please select all that apply)

Vision (e.g. due to blindness or partial sight)

Hearing (e.g. due to deafness or partial hearing)

Mobility, such as difficulty walking short distances, climbing stairs, lifting and carrying objects

Learning or concentrating or remembering

Mental Ill Health

Stamina or Difficulty Breathing

Social or Behavioural (e.g. Autism, ADD)

Other

Prefer not to say

If other, please state

Caring responsibilities

Do you have any caring responsibilities?

Caring

None

Primary carer of a child/children under 18

Primary carer of a disabled child/children

Primary carer of a disabled adult

Primary carer of an older person

Secondary carer (another person carries out the main caring role)

Prefer not to say

VOLUNTEER DETAILS FORM

Your Details

Emergency Contact Details

Support Worker Details

Volunteer Equality and Diversity Monitoring

Ethnicity

Disabilities

Caring responsibilities

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