Volunteer application Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Title (Mr/Mrs/Ms/Other)First name/sSurnameDate of birthAddressCityPostcodeEmailTel. noMobile noEmergency contact nameRelationship to you (Emergency contact)Emergency contact tel.Special needs / requirementsDo you have any special needs or requirements that we can help with to ensure that your volunteering with us is a positive experience? Please share any relevant details below.Special skills / relevant experiencePlease list any special skills or experience that you feel to be relevant to your application to volunteer at CentrePeace.Volunteering opportunities (tick all that apply)ShopCafeCounsellingCompanionshipOtherPlease tick shaded box to indicate which volunteer role you are interested in.Other volunteering role (please explain briefly)Availability – AM shifts (10.00–1.00)MonTuesWedsThursFriSatCentrePeace shop and café are open from 10.00–4.00 on Mondays to Fridays and 10.00–2.00 on Saturdays. Please indicate below the shifts you could be available for by ticking the shaded boxes.Availability – PM shifts (1.00–4.00)MonTuesWedsThursFriSatReference 1 – NamePlease provide us with details of 2 people we can contact for a reference. One should be a personal friend (known for at least 3 years) and the other ‘professional’ (e.g. employer, doctor, support worker, social worker, teacher etc.).Reference 1 – Relationship to youReference 1 – AddressReference 1 – EmailReference 1 – Contact numberReference 2 – NameReference 2 – Relationship to youReference 2 – Address Reference (tick – Reference 2 – EmailReference 2 – Contact numberSignature Clear Signature Date Submit
