SurnameForenamesTitleDate of Birth (DD/MM/YYYY)Address House Number & Street Name Address Line 2 Town / City County Postcode Telephone Number (optional)Mobile Number (optional)Email Address Emergency Contact (Name & Number)Please describe any skills or qualifications that you could use as a volunteer:How did you hear about the PROSPECTS Foundation?VOLUNTEER ROLES: Please select from the list below the type of activity you are interested in (please tick all that apply) Practical Conservation Activities Food Growing Helping at Events Admin & Office Help Traditional Crafts Leading Walks / Bike Rides Other (use box below to describe) VOLUNTEER ROLES (Continued)Please complete if you ticked 'Other' abovePlease describe any disabilities / impairments and details of any medication we should know about in the event of an emergency:Why do you want to volunteer with Prospects?Would you like to become a member of PROSPECTS?*YesNoNEWSLETTER MAILING LIST I would like to be kept up to date with what’s going on at PROSPECTS. I would like to receive the PROSPECTS Foundation monthly Events Bulletin/Newsletter, regular updates about PROSPECTS activities, courses and training events as well as information about current and future projects. Please tick the box to sign up.YesNoOur Privacy Statement detailing how and why we use your information is available on our website at www.prospectsfoundation.org.ukDECLARATION OF CONVICTIONS Because volunteers work alongside vulnerable people, Prospects Foundation has a responsibility to safeguard the interests of both clients and volunteers, do you have any convictions that you are required to disclose or other information you wish us to know?*YesNoIf yes you will need to complete an additional form, this is unlikely to affect your opportunity to volunteer.Do you have difficulties with: Lifting & Carrying Walking long distances Controlled use of hand tools Following verbal instructions Walking over steep or uneven ground Support while volunteering Will you be volunteering with the help of a carer or support worker?*YesNoIf yes you will need to complete an additional form, this is unlikely to affect your opportunity to volunteerDate Date Format: MM slash DD slash YYYY Δ