2018-2019 VOLUNTEERING with PilgrimHearts

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


      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   Tuesdays ( Mondays from December ) or Thursdays

      Night Shelter availability Mon Tue Weds Thur Fri Sat Sun         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                     

     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 …………………………..                              Oct 2018