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Volunteer

Fill in the application form below to join as a volunteer and help reduce loneliness and isolation amongst older people

Title*
e.g. Mr, Mrs, Miss
Name*
First nameLast name
Address*
Address Line 1Address Line 2City / TownCountyPost Code
Home Telephone*
Work Telephone
Mobile Telephone
Date of Birth
Email Address
retype email address
Volunteering roles*
- Regular Driver - one Sunday afternoon a month
- Coordinator - to ensure smooth running of the group
- Reserve Driver - to help occasionally
- Host a tea party once or twice a year
Please check all that apply
Do you have any criminal convictions which are not legally spent
- Yes
- No
Volunteer Driver Details
Car details
Please enter car make and type
Registration Number
Car registration
Number of seats in your vehicle
Number of seatbelts
Number of doors on your vehicle
Insurance
- Comprehensive
- 3rd Party Only
Do you have a full driver's license
- Full license
- Provisional license
Endorsements
Please list any extra license endorsements
Volunteer Host Details
Number of steps
Number of steps to be negotiated
Downstairs toilets
- Yes
- No
Parking and access to your house
Please give details of parking at your home and any relevant information about access to your house including steps
REFEREE INFORMATION
Please give details of two people who will provide a personal reference for you (they can NOT be a partner of a member of your family)
DETAILS OF FIRST REFEREE
Referee 1 Name
First nameLast name
Referee 1 Address
Address Line 1Address Line 2City / TownCountyPost Code
Referee 1 Telephone Number
Referee 1 Email Address
Referee 1 Relationship
DETAILS FOR SECOND REFEREE
Referee 2 Name
First nameLast name
Referee 2 Address
Address Line 1Address Line 2City / TownCountyPost Code
Referee 2 Telephone Number
Referee 2 Email Address
Referee 2 Relationship
ALL APPLICANTS
ALL APPLICANTS Data Protection Act: I understand and agree that, as part of a Contact the Elderly Group, my details will be held in a confidential database that is only used for communications within the Charity. I confirm that the above information is correct and that I agree to my details being held as set out above.
Please tick the box to confirm
Please confirm*
- I agree to terms
HOW DID YOU HEAR OF US?

Please tell us where you heard of Contact the Elderly?
If you know of anyone who might be interested in receiving more information about Contact the Elderly, please provide details below and we will send information to them.
Name
First nameLast name
Address
Address Line 1Address Line 2City / TownCountyPost Code
Telephone
Email address
Relationship

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0800 716543

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Contact the Elderly is a registered charity in England and Wales (1146149) and in Scotland (SC039377). Company Number (07869142) Registered office: 15 Henrietta Street, London WC2E 8QG.

Volunteer

Fill in the application form below to join as a volunteer and help reduce loneliness and isolation amongst older people

Volunteer Driver Details

Volunteer Host Details

REFEREE INFORMATION

DETAILS OF FIRST REFEREE

DETAILS FOR SECOND REFEREE

ALL APPLICANTS

HOW DID YOU HEAR OF US?

Become a volunteer

Be our guest

Support our work

Call our freephone

Be our
guest