North West Kent

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Volunteer Registration and Health and Safety Form

Please note: We are currently not accepting any more volunteers because we have reached our limit. You can still continue to apply, but your application will be placed into the waiting list and you will be contacted when spaces become available.

Please complete the areas below to the best of your knowledge. The form may look rather scary but it's standard procedure for volunteering - please don't be put off! If you would prefer to complete a paper copy of the form, just give us a call and we'll be happy to send you one.

Once you have submitted your information, a member of staff will be in touch with further information on the volunteer work we do. Your details will also be added to our database so that you will receive details of all the volunteer projects we are carrying out each month.

Personal Contacts

Name :-

Address :-

Telephone Number :-

E mail (If you have one) :-

Date of birth :-

Do you have any experience that will help you with conservation volunteering ? If yes then please briefly explain the experience you have.

Emergency Contacts

1). Name :-

Telephone Number :-

Relationship to you :-

2). Name :-

Telephone Number :-

Relationship to you :-

Medical Information

Has you doctor ever said that you have a heart condition?

Do you feel pain in your chest when you do physical activity?

In the past month have you had a pain in your chest when you were not doing physical activity?

Do you lose your balance because of dizziness or do you ever lose consciousness?

Do you have a bone or joint problem that could be made worse by a change in your physical activity?

Do you have diabetes?

Do you have asthma?

Are there any other medical conditions that we should be aware of?

If you have answered YES to any question then please give details (you will need to see your GP before volunteering with us)

Was your last Tetanus booster within the last 10 years?

If not then you will need to arrange a booster with your GP before volunteering with us.

Under the Data Protection Act 1998, this personal information will be securely held by the North West Kent Countryside Partnership (as part of Kent County Council) solely to ensure that Health and Safety risk on volunteer projects is minimised. This information will not be used for any other purpose, nor passed onto any third party.

Address :- North West Kent Countryside Partnership, Mead Crescent, Mead Road, Dartford, Kent, DA1 2SH
Tel No :- 01322 294727

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