2018-2019 VOLUNTEERING with PilgrimHearts

For Drop In or Night Shelter (please circle your choices)


      First name: …………………………. Surname: …………………………..……………………….     Gender: …………   
  
      D.O.B:   ………………   Email: ……………………………………….……………        Mobile:  …………………………

      Address:     ………………………………………………………………………………………………..………………………

      Referees Name: (Or Name of your local church)     ……………………………………………………………………..

      Address: …………………………………………………………………………………………………………………………..

      Phone:          ………………                                         Email:           ……………..

      Signature:                                                                 Date:  


                                               Please circle your choice/s from the following :        

      Drop In (at St Andrew’s)    Mondays 12 am to 2 pm or Thursdays  11 am to 2 pm

      Night Shelter availability  Mon Tue Weds Thur Fri Sat         Sessions  Evening  Night  Morning

      Volunteer at sessions - Cook at sessions - Laundry done at home - Admin help - Mentoring a guest - Driving

     Have you a valid DBS check?                                YES  / NO               (please circle your selection)

     If so, who did it? ………………………                                              and when was it done?……………………….

     Do you have a valid First Aid qualification?          YES  / NO  

    Mental Health First Aid certificate                          YES  / NO  

     Food Hygiene certificate?                                     YES  / NO   

     Safeguarding training                                           YES  / NO            

     Previous relevant experience (for new applicants only)






     I agree to follow the Volunteers Handbook guidelines and will work as requested by the organisers.


     I give permission for Pilgrim Hearts to store my data for the running of the Night Shelter, Drop In and         Mentoring services.



     Signed………………………………………    Dated …………………………..                              Jan 2019



   PLEASE POST TO Pilgrim Hearts 24 YORKSHIRE PLACE, BRACKNELL, RG42 3XE

or scan and Email to pilgrim.hearts@gmail.com