Company Registration Number: 5589693 Registered Charity Number: 1113065
Registered Office:
Phone: 01543 500404 Fax: 01543 500406
E-mail: enquiries@chase-cvs.org.uk
Title*: First Name*: Surname*: Preferred Name:
Address*: Town: County: Postcode*:
Phone number: Mobile number: E-mail:
(Any information you feel will help us to find an appropriate opportunity for you)
Social Give something back Gain work experience Build confidence Improve employment prospects
Interest Use my time usefully Gain new skills Improve health
Other (please state):
Which district do you want to volunteer in? *
Cannock Chase South Staffs
When are you available to volunteer? *
How much time each week would you like to spend? *
Not specific 4-6 hours Over 10 hours
1-2 hours 6-8 hours Not regular hours
2-4 hours Up to 10 hours
Do you have a full driving licence? * Yes No
Do you have your own transport? * Yes No
Do you have any special requirements that need tobe taken into account when finding you an opportunity? * (e.g. access requirements etc). No Yes (please give details)
Tick the 'Yes' box for any of the following that interest you, or the 'No' box if you definitely don't want to do something. You must tick 'Yes' for at least one interest and activity.
Are you interested in one-off volunteering? * Yes No
How did you hear about the volunteer centre? (please give details)