Digital Champion Volunteer Registration Form
Private & Confidential
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First name *
Last Name *
Email *
Address *
Phone number *
Date of Birth *
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How would you prefer to be contacted? *
Approximately how many hours per week would you like to volunteer? *
Where would you like to volunteer? (reasonable travel expenses are paid) *
Please give details of any skills and interests you feel are beneficial to this role: *
Please give details of any previous voluntary experience you have: *
Please give details of any learning or physical disability,  mental or physical illness, caring responsibilities, transport issues etc which may affect the volunteering you want to do. *
Please provide an email address and contact number for TWO referees - they can be friends/employers (it can't be someone related to you)   *
Do you have any spent or unspent convictions that would bar you from working or volunteering with children or vulnerable adults. *
If you have responded 'yes' to the above statement please indicate if your conviction is Spent or Unspent.  
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Please Note
Please note: In order to support you in accessing appropriate volunteer support and in the interest of the public, we may be required to share this information with organisations involved in the project. If your conviction is not spent we may also discuss these referrals with your probation officer.
 Emergency contact
Please provide the details of someone you would like us to contact on your behalf in the unlikely event of there being an emergency.  
Emergency Contact: First name *
Emergency Contact: Last name *
Emergency Contact: Phone number *
Emergency Contact: Address *
We provide volunteers with a t-shirt and hoodie. Please choose your size. *
GDPR
To comply with the UK Data Protection Act 1998, your permission is needed before we are able to use an image or any near likeness of you. No image or likeness will be used without your permission. If it is given, you may remove your permission at any time by contacting the person named as the Volunteer Coordinator.

I give permission as the named person above for my likeness to be used for the purposes of Include-IT Mersey Project's internal and external publications, newsletters, presentations, social media, communications, Include-IT Mersey Website and local/national newspaper articles.  
Name *
Date *
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Important Information
Personal data that you provide to Include-IT Mersey will be held in accordance with the Data Protection Act 1998. To enable Include-IT Mersey to offer the highest quality service, it may be necessary to share your information with other agencies. We understand the information that you provide is of a sensitive and private nature, therefore all staff and volunteers are bound by a confidentiality agreement.

I hereby confirm that the above details are correct to the best of my knowledge and I have read and understand the Important Information.
Name *
Date *
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