uid - volunteer registration form

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Personal Details Equal Opportunities Surname:* Title: Forename/s:* Home Address:* Postcode: NI Number:* Contact Number:* Gender:* (please tick) (please tick) Disability: (please tick) Date of Birth:* DD/MM/YY (Questions marked * are required) Female Rather not say No Yes Rather not say Male The United Reformed Church 39 Convent Street Swansea - SA1 2BX Contact: [email protected] Contact Number: Relationship: How did you hear about the Unity in Diversity Group? Volunteer Registration Form Email: Are you: community member asylum seeker refugee Name: Next of Kin

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Page 1: UiD - Volunteer Registration Form

Personal Details

Equal Opportunities

Surname:* Title:

Forename/s:*

Home Address:*

Postcode:

NI Number:*

Contact Number:*

Gender:*(please tick)

(please tick)

Disability:

(please tick)

Date of Birth:* DD/MM/YY

(Questions marked * are required)

Female Rathernot say

NoYes Rathernot say

Male

The United Reformed Church39 Convent StreetSwansea - SA1 2BX

Contact: [email protected]

Contact Number:Relationship:

How did you hear about the Unity in Diversity Group?

Volunteer Registration Form

Email:

Are you: community member asylum seeker refugee

Name:Next of Kin

Page 2: UiD - Volunteer Registration Form

How would you describe yourself?Choose ONE section from A to E, and then tick the appropriate box

Declaration:

When you sign this form you agree that we can share your information with The Big Lottery, which provides money for our activities. We’ll keep your informaton safe in line with the Data Protection Act 1998.

Prefer not to say

BritishEnglishIrishScottishWelshAny other White background, please write in box

Asian or Asian British

Black or Black British

Chinese or other ethnic group

Mixed Heritage

White

White and AsianWhite and Black AfricanWhite and Black CaribbeanAny other Mixed background, please write in box

ChineseAny other, please write in box

AfricanCaribbeanAny other Black background, please write in box

A

B

C

D

E

F

BangladeshiIndianPakistaniAny other Asian background, please write in box

Participant Signature:* Date:* DD/MM/YY

Date:* DD/MM/YYStaff Signature:*

Staff Use Only