Age Range*

8-11
12-18
Adults

First Name*

Surname*

Address Line 1*

Address Line 2

City

County*

Postcode*

Email*

Date of Birth*

School Name*

School or College Name*

Do you have a religion? If so what is it?*

What is your Ethnic Background?*

What is your sexual orientation?*

Heterosexual
Lesbian/gay
Bisexual
Rather not say

Who do you live with?*

Other*

Name of Parent or Guardian*

Name of parent/Grandparent/Foster Carer/Social care Worker*

Contact Number*

Contact Email Address*

Emergency Contact Name*

Emergency Contact Number*

Do you have any illnesses, allergies or anything else we might need to know? (such as asthma, epilepsy etc)*

How did you hear about Stepney Bank Stables?*

Why do you want to volunteer?*

How would you rate how confident you feel when trying something new on a scale 1 to 10?*

What skills do you already have that would help you in your volunteering?*

What skills are you hoping to gain or develop through volunteering?*

Do you receive any support from external services i.e. education welfare or social services?*

Do you take part in any other sports on a regular basis? Or so, which?*

Do you have any previous experience with horses?*

How did you hear about the junior volunteer club/youth work?*

Is there any other information which you think might make the young person eligible for a funded space (i.e. being a “looked after” child, a young carer or other personal issues)*

To help us know a bit more about your child, could you indicate if any of the following apply?*

Struggle to make friends, Has problems at school, Quiet/shy, Young carer, Lacks confidence/self esteem, ‘Looked after’

Please let us know which sessions are most convenient for you from the following options:*

Mon 5-7pm, Wed 5-7pm, Fri 5-7pm, Sat 1-3pm

Parent/Guardian Name (if under 16)

Referees:

All volunteers at Stepney Bank Stables will be in contact with children and young people and will require references from 2 independent referees that are not friends, family members or partners. They should have known you for at least one year.

1st Referee Name*

1st Referee Email*

2nd Referee Name

2nd Referee Email

Availability*

We are open Monday – Friday 9am – 9pm. We expect all volunteers to commit to 2-4 hours weekly. Please let us know when you are available.

Declaration*

I have not incurred any criminal convictions nor have I committed any offences of abuse or causing harm to children or young people, or any offence which may be relevant to my volunteering at Stepney Bank Stables.

The Rehabilitation of Offenders Act 1974 (Exemptions Order 1975), in relation to this area of work, states that it is my responsibility to inform my Supervisor of all convictions prior to me being registered as a Volunteer.

In addition it is also my responsibility to inform my Supervisor of any criminal, child protection or disciplinary proceedings taken against me during the period of my volunteering at Stepney Bank Stables.

If I wilfully or negligently withhold this information, Stepney Bank Stables reserves the right to immediately cease to offer access to all Volunteering arrangements.

I agree that the information given on this form is correct.

I give Stepney Bank Stables permission to contact referees and use my information.

Photographs

We sometimes take photos during sessions to use as evidence for our funders, and to use on our social media sites. Please tick if you DO NOT want your photographs taken for our social media or website.

Once we have received this completed form, we will contact you to let you know when we have available spaces and arrange your first session. Junior Volunteer Club is funded at the discretion of Big Lottery and we will use the information provided in this form to assess if you meet the funding criteria. If you do not meet the funding criteria, you can still come to the youth work sessions, but there will be a charge of £10 per session.

Comments

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Referees: