I want to be a COVID-19 Community Volunteer

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

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