Natures Gym Registration Form

Natures Gym Registration Form

Volunteer Registration Form

When you have completed this registration form, please email it to or post to:Nature Conservation Officer, Lewisham Council, Greenscene, Wearside Service Centre, Wearside Road, London SE13 7EZ

Your details

Title / Mr Mrs Ms Miss / Full name
Address
Mobile phone / Other phone
Email / Date of birth
Shoe / wader size (some of the work we do requires waders)
Do you have specialist knowledge of (please tick)
Amphibians / Invertebrates / Wildflowers
Birds / Fungi / Other (please specify below)
Butterflies/Moths / Mammals
Have you done any volunteering before? (please tick)
Yes / No
If yes, please give details of what you did, where and who with (This doesn’t have to be conservation volunteering).
Are there any goals (personal or educational) that you would like to achieve through your volunteering? (please tick)
Yes / No
If yes, please give details of any goals you would like to achieve. We can then work out an individual programme with you to help you achieve these.
Do you have any mental or physical health issues we need to be aware of (such as heart problems, diabetes, or phobias)? (please tick)
If yes, please give details. This information will be used to assist with task allocation and so that the relevant staff/health professionals can be contacted in the event of illness, accident or emergency.
Are you under any medication that could affect your ability to perform any of the regular activities carried out on Nature’s Gym sessions as listed below (please tick)
Yes / No
Please tick any activities you feel are not suitable. This information will be used to assist with task allocation. We understand that this may alter regularly, so please keep us informed so we can ensure you get the most benefit from the sessions.
Digging with mattocks & Spades / Tree felling (by hand)
Carrying (Loads vary in weight / Use of cutting implements (secateurs/loppers)
Planting / Working in uneven areas (including slopes & riverbanks)
Slash cutting (of meadow grasses) / Working in water

Contact details
for next of kin/preferred contact /key or support worker (in case of emergency)

Please provide details of the best person to contact in case of emergency. If you have a key/support worker, please also provide contact information for them.
NEXT OF KIN
Name / Relationship to you
Address
Mobile phone / Other phone
KEY WORKER (if different from above)
Name / Organisation
Address
Mobile phone / Other phone

Marketing Information

How did you hear about Nature’s Gym?
Newspaper (Which one) / Word of mouth (Who)
Postcard (Where from) / Referral from a doctor (which area)
Poster/leaflet (Where) / Other (please state)
LB Lewisham Advertising (Website/Lewisham Life etc.)

Equalities monitoring

Equalities monitoring is the collection of information which helps services ensure that they are providing a fair and inclusive service. The information that you provide on this form will remain strictly confidential in accordance with the Data Protection Act. If you are unhappy about answering a particular question you do not have to.

White / Black or Black British / Asian or Asian British / Mixed Race
White British / Caribbean / Pakistani / White & Black Caribbean
White Irish / African / Bangladeshi / White & Black African
Other / Other / Indian / White & Asian
Chinese / Other
Other
By returning your completed registration form, you acknowledge that:
  • you fully understood the nature of the tasks involved &
  • you are declaring yourself fit to undertake them and/or have sought medical advice.
Please get in contact if you have any further queries.