Occasional Volunteers Update

Name*
Title First Last
Address
Street Address City State / Province / Region ZIP / Postal Code
Phone
Email*
Date of birth*

We need this information for insurance purposes
Emergency Contact Name*
Emergency Contact Number*
Relationship to you?*
Do you have any conditions or medication we should be aware of?
This will help us to ensure your safety whilst you are volunteering.
How did you hear about being an Occasional Volunteer?*
I am happy to volunteer as
I am happy to be contacted by Havens Hospices about volunteering at future events/colletions by:*
- by post
- by phone
- by email
- by text
I give permission for Havens Hospices to send me information about the charity via email (including fundraising and volunteer news)
- Yes
- No
Health and Safety Guidelines*
- I confirm that I have read the Health and Safety information and fully understand the information described within it.
- I confirm that I am aware of my responsibilities in relation to Health and Safety.

Occasional volunteers staying in touch