A Community Mental Health Resource

Volunteer Application Form

Full Name:	Click or tap here to enter text.

Address:	Click or tap here to enter text.

Post Code:	Click or tap here to enter text.

Tel No:	Click or tap here to enter text.

Mobile No:	Click or tap here to enter text.

Email:	Click or tap here to enter text.

Reason for Application/Relevant Experience:

Click or tap here to enter text.

Special Interests or Hobbies:

Click or tap here to enter text.

Opening Hours – Please indicate preferred time(s)

Day	Day time hours – 9.30am to 3.30pm	Evening Opening
Monday	AM ☐	PM ☐	3.00 pm – 5.00pm ☐
Tuesday	AM ☐	PM ☐
Wednesday	AM ☐	PM ☐	5.00 pm – 7.00 pm ☐
Thursday	AM ☐	PM ☐
Friday	AM ☐	PM ☐
Saturday	AM ☐	PM ☐

Please supply two references

1. Name: Click or tap here to enter text.	2. Name: Click or tap here to enter text.
Address: Click or tap here to enter text.	Address: Click or tap here to enter text.
Tel: Click or tap here to enter text.	Tel: Click or tap here to enter text.

Signature: Click or tap here to enter text.

Date: Click or tap here to enter text.

Please return application form to:

Steve Wakefield

Assistant Manager

Waddington Street Centre

3 Waddington Street

Durham

DH1 4BG

Tel: 0191 386 0702

Email: swakefield@waddingtoncentre.co.uk

Please note that all volunteers

will be subject to DBS enhanced disclosure regulations.