REGISTRATION FORM (this form is confidential and remains with the coordinator at all times)
Information requested is for your safety and security and to safe guard all TimeBankers.
Personal Details
Mr/Mrs/Miss
/
Name:
/
Gender:
D.O.B:
for funding requests & birthdays /
Landline No:
/
Mobile Phone No:
Email:
/
Internet User: Yes / No
Address:
Housing Type: Flat / Bungalow / House / Mobile home
/
Living: Alone / with family / with spouse / Other
Mobility and Transport
Please give details of any disabilities or mobility problems: (NB: This is to give us an indication of your ability and needs) State if use mobility aids eg: wheelchair,crutches.
Do you hold a current UK Driving Licence? Yes/No / Do you own your own car?: Yes/No
Emergency contact – on file in case needed when volunteer calls
Name: / Relationship
Contact telephone number/s
Doctor’s Name/Telephone No:
State any allergies or anything we need to be aware of:
Are there any tasks that you would like to be done or helped with now? Please give a detailed description
Time Bank Standards of Care – this information is to make sure that our members act as we would all like – therefore we get everyone to agree and sign up to these conditions
As a participant of TimeBank I agree to:
Respect another participant’s privacy or confidentiality Respect other participant’s viewpoints, and to not pressurise another participant to accept your religious beliefs or political views.
Not involve friends or relatives in time bank activities by bringing them to a participant’s home or venue, unless agreed with the TimeBank as being part of a group activity.
Not to ask for or accept money, gifts or tips from other participants, unless agreed with the coordinator. Do not eat or drink a participant’s food and drink, unless invited to do so. Respect a no smoking policy in a participant’s home or venue. Not use any possessions of the participant, including the telephone, unless given clear permission to do so. Always treat other participants respectfully. Do not exchange hours unless the TimeBank is aware (otherwise forfeit insurance cover). TimeBank respect and support the 2010 Equality Act. Our fully detailed policies are available in the TimeBank Handbook which is on line in the members Section or a hard copy can be requested.
The TimeBank may maintain a photographic record of the activities undertaken by participants. These may be used in our newsletter and for general publicity, including the TimeBanks UK website. Please state if you are happy with this:
I give my permission for photos to be used for the Time Bank publicity. Yes/No
I agree to abide by the above Standards of Care and confirm that the information given on this form is correct to the best of my knowledge
Signature:
Print Name: / Date:
How did you find out about St Neots Time Bank?......

Monitoring
Smoker Yes/No
Tolerate Dogs Yes/No
Tolerate Cats Yes/No
Male or Female
Nationality:
References
We want to ensure that as a Time Bank Member you and your family are safe, so for everyone involved in the scheme we take up references. References should not be from a spouse or partner or an immediate member of your family, but can be a friend or neighbour.
Reference 1 / Reference 2
Name: / Name:
Address: / Address:
Telephone: / Telephone:
Email: / Email:

Return completed form to: St Neots TimeBank

12 Glenariff Close

EYNESBURY,

Cambs,

PE19 2QW

Postal address only

or email to

Examples of Skills you may need help with or able to do

Add N for skills needed and G for Skills Offered

Arts & Craft / Home / Outside
Craftwork / Carpentry / Building Work
Crochet / Carpet Layer / Car Repairs
Dancing / Clearing/Cleaning / Car Washing
Design Work / Cooking / Catering
Embroidary / Home Baking / Cycle Repairs
Jewelery / House Sitting / Delivering flyers etc
Knitting / Housework / Dog Walking
Metalwork / Ironing / Gardening
Painting/Drawing / Plant Watering / Grass Cutting
Poetry / Plumbing / Gutters Cleared
Pottery / Plastering / Help with events
Sewing / Shopping / Home Repairs
Woodwork / Simple DIY / Motorbike Repairs
Tiling / Moving/Lifting
Office / Washing / Outside Painting
Book Keeping / Ironing / Photography
Budgeting / Window Cleaning / Planning a garden
Computer Skills / People / Painting
IT Skills / Coffee Morning / TimeBank Admin help
Design Work / Companionship / Offer of Venue
Form Filling / Debt Advice / TimeBank Donations
Letter Writing / Driving
Marketing / Enrolments
Relaxation Therapies / Tuition
Printing / Errands / GCSE & A level
Publicity Work / Escort to appointments / Maths, Science
Surfing the Net / Giving Lifts / Geography
TimeBank Admin / Experienced in SEN
TimeBank Meetings / Legal Advice / & deaf impairment
Translations / Listening / English
Typing / Meetings / Italian
CV writing / Pet Care / Spanish
Phone Friend / Danish
Other Skills not listed: / Prescription Collection / French
Story Telling / DIY Skills
Reading aloud / Plastering
Visit Housebound people
Stress Counselling
Beauty Therapy / Primary school help
Dance
Youthwork

www.stneotstimebank.org.uk

Town Council Awards Winner ‘Charity of the Year 2015’