What Volunteering Opportunity are you interested in?

Support Worker Cool Friend Fundraiser Massage Therapist Fundraising Collector

Are you over the age of 18?

Yes No

If you are under 18, are you 16 or over?

Yes No

Do you drive?

Yes/and have use of a car Yes/do not have use of a car No

Name

Address

Tel No  * required

Mobile No

E-mail

Are you available during the day? Yes No

In order to ensure your general health and safety is considered please describe any health problems or disability that may effect your ability to volunteer in this role.

Why would you like to volunteer with The Butterfly Trust?

Do you have any personal knowledge of Cystic Fibrosis? Yes No

Please desrcibe any experience or skills you have that would make you a suitable volunteer for this role?

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 volunteering with The Butterfly Trust References 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. Name  * required Address Tel No Name  * required Address Tel No