Personal Details

Emergency Contact Details

What role(s) are you interested in?

When are you able to volunteer? 

Please provide the details of your reference or references.

Hospice roles require 2 references -If possible 1 reference should be professional and the other personal.

ALL other roles require 1 reference - Either personal or professional.

References must not be a family member and need to have known you for at least 2 years.

Reference 2 (for those applying for hospice roles only)

Additional Information

GP Information ( Your GP will only be contacted with your permission)

If Yes please give details on a separate sheet and enclose with this application. The information will be treated in strict confidence.

Under the Rehabilitation of Offenders Act 1974, you are required by these provisions to declare all criminal convictions however long ago these occurred. Disclosure of an offence will not necessarily be a barrier to becoming a volunteer with us.

DBS checks: successful candidates may be required to complete a DBS check and personal identification documents will be needed as part of this process.