Appendix 2
A
Seated Exercise Volunteer
VOLUNTEER FORM
GENERAL INFORMATION
Name ______Date of Birth ______
Address ______Male q Female q
______GP Practice ______
______GP Tel No ______
______Emergency Contact Name
Tel No ______
Mobile No ______Emergency Tel No ______
E-Mail ______Occupation ______
______Previous Occupation______
Do you suffer from a long-term condition? (Please give details): ______
______
CATEGORIES
We have identified a number of categories where we would like volunteers to be involved. Please tick
all that interest you:
1. The Provision of Refreshments
This maybe preparing and/or serving tea, coffee and biscuits or clearing up afterwards
2. Being a ‘Buddy’
This would entail ‘buddies’ meeting and greeting new participants and assisting them through
their first one or two sessions.
3. Being a ‘Befriender’
‘Befrienders’ would be expected to guide and assist individuals over a longer period of time. This
could be a role that is taken over, after an initial settling-in period by the participant’s family or
friend
4. Acting as an Assistant to the Exercise Leader
This could entail setting-up and clearing chairs and/or equipment. Suitably trained, briefed and
willing volunteers may be asked to demonstrate exercises or assist individuals through particular
movements where they require assistance
5. Being an Exercise Leader
This will require an acceptable level of competence gained through previous experience or
completion of agreed training and assessment programme. They would be expected to commit to
leading sessions as part of a long-term activity/exercise programme or be prepared to commit to
being a short-term or emergency stand-in Exercise Leader
6. Deliver Exercise Sessions on a One-to-One Basis
Provide a series of six sessions in a person’s own home when they are unable, at that point, to
attend a group
7. Have you any hobbies, skills or interests? (Please tick all that interest you)
8. When would you be available for volunteering?
9. Do you feel you have a disability which may require some support to help you volunteer
10. Which of the following would you like to achieve through volunteering? (Please tick all that apply)
11. Any other relevant information or qualifications:
12a. Do you have a Protection of Vulnerable Groups (PVG) registration?
12b. Do you give permission for your contact details to be shared with VAA to enable registration
with PVG scheme?
13. Do you have your own transport?
14. Please give the name and contact details of two referees: