Volunteer Registration Form

Confidential

Volunteers will be covered by North Lincolnshire Councils Insurance Policy. The following information is required for insurance purposes and helping us to match potential volunteers to the most appropriate tasks.

Personal Information

Name
Title
If Other please specify
First name
Last name

Address
Prefix (e.g. first floor flat)
House name/number
Street
Village/Area (e.g. Scawby, Bottesford, etc.)
Town
County
Post code Please input your post code using capitals and include a space between the first and second parts e.g. DN17 5TY.
Email address
Contact telephone no.

Other Information

Date of Birth ^*

Tetanus Jabs up to date

Do you have any medical condition or allergy that you consider may affect your voluntary activity (please include any details of any treatment by a doctor or hospital visit within the last 2 years)

Health Declaration

“I understand that being a volunteer may be physically demanding. I consider myself to undertake the tasks I have expressed an interest in and agree to inform North Lincolnshire Council of any changes to my health.”

Please select ^*

I disagree

I agree

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Volunteer Registration Form

Confidential

Personal Information

Health Declaration