Your information
	Full name  * required Address
	Email address  * required Telephone number
	* required Mobile Number
Volunteering Role
	Are you over the age of 18 Yes No Are you over the age of 16 Yes No Do you drive Yes, and have use of a car Yes, but do not have a car No (Please note that the role of Support Worker often centres on supporting clients to complete complex forms and acting as an advocate on their behalf.  If you believe that you would have the necessary skills and would like to proceed with your application could you please continue with the form) What volunteering role are you applying for Support/Advocacy Befriending/Mentoring Massage Transport Fundraising
	When are you available to volunteer In order to ensure your general health and safety is considered please describe any health problems or disability that may effect you ability to volunteer in this role Why would you like to volunteer with The Butterfly Trust Please describe any experience or skills you have that would make you a suitable volunteer for this role Do you have any personal knowledge of Cystic Fibrosis Yes No Where did you first hear about this opportunity The Butterfly Trust Website Gumtree Advert Butterfly Trust Poster Butterfly Trust Volunteering Leaflet Volunteer Centre Other (please state)
Self Disclosure
	Criminal Convictions The role for which you have applied may involve contact with children and other vurnerable people and is therefore exempt from the provisions of the Rehabilitation of Offenders Act of 1974. All criminal convictions, however old, must be declared. Any information you provide will be treated with the utmost confidentiality and disclosures of offences not relevant to your voluntary role will not adversely affect your application I have never been convicted of a criminal offence I have been convicted of a criminal offence and the details are as follows I agree to inform the Director if I am convicted of a criminal offence while I am volunteering with The Butterfly Trust Please give the names and contact details of two people who have known you for some time and whom we can approach for a reference.  These people should not be related to you but they should know you well enough to be able to give us relevant information about your character and experience.  One of these people should be a current or previous employer Full name  * required Address Email address Telephone number  * required Full name  * required Address Email address Telephone number  * required