Test Volunteer Form

Holidays

Which holiday do you wish to apply for?

You can apply for both holidays if you wish:

First choice:

Second choice:

Volunteer Details

First name:

Last name:

Email:

Home Tel No:

Mobile:

Postal Address: City: Postcode:

Occupation: Height: Weight:

Date of birth

Do you require a specific diet? If yes, please give details:

Do you have any medical condition or disability that might limit your performance as a helper?

If yes, please give details:

Have you volunteered on a 3H Fund Group Holiday before? If yes, please give details:

How did you find out about 3H?

DBS PROCESS

It is a requirement for all volunteers who assist on our holidays to undergo an enhanced Disclosure and Barring Service check (DBS). This needs to be completed before we can offer you a place on the holiday. Persons concerned with the care of the elderly, sick or disabled are exempt from the Rehabilitation of Offenders Act 1974 and are not entitled to withhold information regarding ‘spent’ convictions. Any information given will be treated confidentially and considered only in relation to this application.

Have you ever been convicted of a criminal offence?

Have you had a recent DBS check (within the last 3 years)?

Have you signed up to the online update service?

If you have answered YES to the above, please provide the certificate number and date

Next of Kin Details

Name: Relationship:

Mobile: Email:

Postal Address: Postcode:

Home Telephone Number:

Emergency Contact Details

Name: Relationship:

Home Telephone Number: Mobile:

GP Details

GP Name: GP Telephone Number:

Surgery Address: Postcode:

ADDITIONAL INFORMATION / PERMISSIONS

Please tell us about yourself and why you are applying to be a volunteer on a 3H Fund group holiday. Please indicate below if you are a regular carer (Paid or family member?)

Please state if you have any relevant previous experience of volunteering or caring for a disabled person and list any related skills such as signing or first aid training etc.

After the proper instruction and with the aid of suitable equipment are you prepared to:

- Move and handle people? - Push wheelchairs?

Would you be prepared to share a room with your guest?

Some disabled people are incontinent. Could you cope with this?

Some disabled people cannot, or find it difficult to speak. Would you have the patience to care for someone who communicates non-verbally? (E.g. by alphabet or bliss board)

Travel arrangements:

Data Protection

Under the data protection regulations 1998 and to comply with new regulations coming into effect from 25 May 2018, we need your consent in respect of the following, and would be grateful if you would select your agreement using the dropdowns provided:

1. All your personal data shall be kept confidentially by 3H for a time deemed necessary. 2. 3H will forward your personal data to the necessary parties who will have been made aware of their obligations to abide to all aspects of the new data regulations and particularly in respect of confidentiality and safe keeping. 3. 3H Fund may wish to publish photographs with your first name and/or short video clips which include you, in their various publications, 3H website, Facebook, Twitter and may use your details for other promotional and reporting purposes.

References

If this is your first 3H holiday we will need the details of 2 references.

Your referee must be over 18, must have known you at least 2 years and must not be related to you. Please ensure your referee is agreeable to supply a reference.

Reference 1

Name: Telephone Number: Address:

Email: Occupation: Postcode:

Reference 2

Name: Telephone Number: Address:

Email: Occupation: Postcode:

Training

All volunteers are required to attend a pre holiday training day.

Following the training you are invited to stay for a meal paid for by 3H. Accommodation will also be provided for those who need it.

Would you be available to attend the training day?

How will you arrive at the training day

I wish to stay for the evening meal

I will need accommodation for the Saturday night

Keeping in touch

I would prefer future correspondence from 3H by: