Name

Email Address

Phone Number

Address

Emergency Contact - Name

Emergency Contact - Relationship to You

Emergency Contact - Address

Emergency Contact - Phone Number

Time Available to Volunteer and Frequency

Referee’s Name

Referee’s Phone Number

Do you have any spent or unspent convictions as defined under the Rehabilitation of Offenders Act 1974? (Less minor driving offences) Do you have any spent or unspent convictions as defined under the Rehabilitation of Offenders Act 1974? (Less minor driving offences) Yes No

Do you have any health or medical issues which we should be aware of which would impact on your duties e.g. lifting/carrying objects, respiratory problems etc. Do you have any health or medical issues which we should be aware of which would impact on your duties e.g. lifting/carrying objects, respiratory problems etc. Yes No

How do you think you can best help out at the Museum (think about your qualities and life experiences).