2019-2020 VOLUNTEERING with Pilgrim Hearts

For BRACKNELL Drop In or Night Shelter (please circle your choices)


      First name: …………………………. Surname: …………………………..……………………….     Gender: …………   
  
      D.O.B:   ………………   Email: ……………………………………….……………        Mobile:  …………………………

      Address:     ………………………………………………………………………………………………..………………………

      Referees Name: (Or Name of your local church)     ……………………………………………………………………..

      Address: …………………………………………………………………………………………………………………………..

      Phone:          ………………                                         Email:           ……………..

      Signature:                                                                 Date:  


                                               Please circle your choice/s from the following :        

      Drop In (at St Andrew’s)    Mondays 12 am to 2 pm or Thursdays  11 am to 2 pm

      Night Shelter availability  Mon Tue Weds Thur Fri Sat         Sessions  Evening  Night  Morning

      Volunteer at sessions - Cook at sessions - Laundry done at home - Admin help - Mentoring a guest - Driving

     Have you a valid DBS check?                                YES  / NO               (please circle your selection)

     If so, who did it? ………………………                                              and when was it done?……………………….

     Do you have a valid First Aid qualification?          YES  / NO  

    Mental Health First Aid certificate                          YES  / NO  

     Food Hygiene certificate?                                     YES  / NO   

     Safeguarding training                                           YES  / NO            

     Previous relevant experience (for new applicants only)






     I agree to follow the Volunteers Handbook guidelines and will work as requested by the organisers.


     I give permission for Pilgrim Hearts to store my data for the running of the Night Shelter, Drop In and         Mentoring services.



     Signed………………………………………    Dated …………………………..                              August 2019


   PLEASE POST TO :- Pilgrim Hearts 24 YORKSHIRE PLACE, BRACKNELL, RG42 3XE

or scan and Email to pilgrim.hearts@gmail.com