About You Your Name (required) Email Address (required) Mobile Number Postcode (required) Under 18? YesNo Over 70? YesNo Underlying health conditions requiring you to be self-isolating/shielded? YesNo Valid DBS? (Please note - this is not essential but will determine which roles are appropriate) YesNo If yes, Enhanced or Basic DBS? EnhancedBasic If yes, name of organisation your DBS check is with Full clean driving licence? YesNo Use of Own Vehicle and insurance cover? YesNo Cyclist willing to use bike as transport? YesNo Health or Social Care Professional? YesNo Teacher or Education Professional? YesNo Volunteer Roles Please indicate which of these key roles you are interested in: - Street Volunteer Organiser YesNo Delivering Essential Supplies YesNo Collecting Prescriptions YesNo ‘Getting Online’ Digital Support YesNo Telephone/Online Parent Home Schooling Support YesNo Food Distribution Centres YesNo Dog Walking YesNo Interpreting YesNo If interpreting please state language: Telephone Helpline YesNo Telephone Befriending YesNo Leafleting YesNo Wellbeing Support to Others YesNo Adding capacity to key services (like care homes) in case of staff shortages YesNo Please list any other areas of support you can offer Please list any useful skills or qualifications related to above roles that you have When are you available to help out? Monday MorningAfternoonEvening Tuesday MorningAfternoonEvening Wednesday MorningAfternoonEvening Thursday MorningAfternoonEvening Friday MorningAfternoonEvening Saturday MorningAfternoonEvening Sunday MorningAfternoonEvening Your data Are you happy for us to share your contact details with another volunteer who has signed up from a postcode near you? YesNo I agree that personal data relating to me which has been obtained by Community CVS, including the personal data given by me on this form, may be held and processed either on computer or in manual records and may be disclosed to officers and authorised employees of Community CVS and Blackburn with Darwen Borough Council and used by Community CVS or Blackburn with Darwen Borough Council for any purpose relating to my voluntary work. YesNo I consent to be added to Community CVS mailing list to keep up to date about events and projects. YesNo Δ