VOLUNTEER – AD-HOC & DAY SUPPORT

No one can do everything, but everyone can do something…

Thank you for taking the time to consider supporting Reuben’s Retreat through our ad-hoc volunteering opportunities. Our volunteers have been integral to our progression and development since we launched in August 2012 and without them we wouldn’t be where we

are today. Please complete the form to the best of your ability and if you need any assistance please do not hesitate to contact our Head Office on 01457 680 023. If you are under the age of 16 please contact Reuben’s Retreat in advance of completing this form.

Full name:
Address & postcode:
Email address:
Telephone no.:
Mobile no.:
Emergency contact name (1):
Contact telephone no.:
Emergency contact name (2):
Evening contact no.:

Declaration

I declare that the information I have given above is correct and to the best of my knowledge. I also agree that I:

§  will treat everyone I interact with in a professional and courteous manner when volunteering for Reuben’s Retreat

§  will work collaboratively with others

§  will report any accidents or injuries as soon as safely possible to a member of Reuben’s Retreat staff

§  will not take any action that could threaten the health or safety of myself or others involved with the charity

§  will not discriminate others (on the grounds of race, colour, nationality or ethnicity, disability, age, gender, sexual orientation, marital status or religious affiliation or beliefs)

§  will raise any concerns - regarding myself or others - immediately to a senior member of Reuben’s Retreat staff

§  will not speak to the media regarding Reuben’s Retreat without gaining prior approval from a senior member of Reuben’s Retreat staff

§  will represent the charity to the best of my ability, thank those that support and give to the charity, and that I will smile!

PLEASE TICK AS APPROPRIATE

I am over 18 years of age o Agree o Disagree

I agree to allow emergency medical treatment in hospital if necessary whilst volunteering o Agree o Disagree

I do not have a criminal record (or any matters pending that may result in a criminal conviction)* o Agree o Disagree

I have received and read a copy of the Volunteers Policy Agreement o Agree o Disagree

I would like to be contacted by Reuben’s Retreat regarding ad-hoc volunteering opportunities o Yes o No

*Please note a criminal record will not automatically preclude you from our volunteer opportunities and your disclosures will be kept confidential and only viewed by relevant members of Reuben’s Retreat management team or Board of Trustees.

Signature: Date:

Please return your completed form to:

Support & Breaks Manager, Reuben’s Retreat, Park Crescent, Glossop, SK13 7BQ

Alternatively, please email to:

FOR OFFICIAL USE ONLY / Internal reference: / Date received:

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EQUALITY & DIVERSITY MONITORING

No one can do everything, but everyone can do something…

Reuben’s Retreat recognises the benefits of a diverse community of beneficiaries, volunteers, staff and supporters, and we are committed to being an inclusive organisation where everyone is treated with respect, dignity and where there is equal opportunity for all.

Whilst we ask you complete the following information you are not obliged to do so; the answers you do provide will be treated anonymous and stored confidentially and securely.

Gender: / o Male o Female o Rather not say
Age: / o Under 25 o 26-35 o 36-45 o 46-55 o 56-65 o 66 or over o Rather not say
Please state what you consider your ethnic origin to be:
Ethnicity is distinct from nationality and the categories below are based on the 2001 Census
o Indian o Pakistani o Bangladeshi o Other ______
o Caribbean o African o Other ______
o Chinese o Other ______
o White & black Caribbean o White & black African o White & Asian o Other ______
o English o Irish o Scottish o Welsh o Other______
o Rather not say
Faith:
Which group below do you most identify with?
o Buddhist o Christian o Hindu o Jewish
o Muslim o Sikh o Rather not say o Other ______
Do you consider yourself to have a disability?:
The Disability Discrimination Act 1995 (DDA) defines a person as disabled if they have a physical or mental impairment which has a substantial and long term (i.e. has lasted or is expected to last at least 12 months) adverse effect on one’s ability to carry out normal day-to-day activities.
o Yes o No o Rather not say
Would you consider yourself to be:
o Bisexual o Gay o Heterosexual o Lesbian o Rather not say
Are you currently:
o Employed o Unemployed o Full-time parent or carer o Retired o Student/Adult student o Rather not say
How many children (aged 16 or under) do you have living in your household?:
What are the first 3 digits of your postcode?:

Keeping Volunteering Voluntary statement

As a charity we know the value of volunteering - volunteering means people independently choosing to give their time freely to help others and make the world a better place.Workfare schemes force unemployed people to carry out unpaid work or face benefit sanctions that can cause hardship and destitution. Webelieve in keeping volunteering voluntary and will not participate or support your involvement in government workfare schemes.

Under the terms of the Data Protection Act and the Data Protection Directive this information will be treated in a secure and confidential manner. Reuben’s Retreat may be required to give some of this information – only where relevant and appropriate - to the bodies responsible for regulating and/or funding Reuben’s Retreat.

Please return your completed form to:

Support & Breaks Manager, Reuben’s Retreat, Park Crescent, Glossop, SK13 7BQ

Alternatively, please email to

Reuben’s Retreat Equal Opportunities (Revision 1.0) Page 1 of 1