Become a Volunteer Name * First Name Last Name Email * Phone (###) ### #### Date of Birth MM DD YYYY Employment Status Employed Employed Part Time Self Employed Retired Student Other Please give an indication of the maximum number of hours you are willing to commit per month or indicate if this can be flexible: (your support can be as flexible as you like, every moment you give is appreciated) * Which days would you be available: Monday Tuesday Wednesday Thursday Friday Saturday Sunday Preferred way for us to contact you: * Phone Email No Preference Please indicate the support you would be willing to undertake Telephone Befriending Shopping/taking someone to shop Collecting parcels/prescriptions Driving – e.g. doctors/hospital appointment Basic DIY jobs within home e.g. replacing lightbulbs Household jobs e.g. cleaning Hoovering/light cleaning Putting out bins/disposal of rubbish Light gardening In Person Befriending Helping at a community Warm Space/Coffee morning Emergency Contact Name First Name Last Name Emergency Contact Phone (###) ### #### Realtionship to Volunteer GP Practice and Phone Number Audit: The Good Neighbours-Rural Peterborough Trust may be evaluated by funders the who may wish to contact you for personal feedback. Please confirm you are happy for us to pass on your contact details: Yes No To comply with Data Protection regulations, we require your explicit written consent in order to be able to hold your details to be able to communicate with you. By completing the online form and submitting, you are providing this consent and for GNRP to contact you. Thank you. Your details will be kept securely and not passed on to any third party, unless agreed or in the case of an emergency. For more details, please refer to our Privacy Policy. Signature (please re type full name if submitting online): Date MM DD YYYY Thank you!
