Arts 4 Dementia

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Empowering people with memory loss through artistic stimulation

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Volunteer Registration


Please complete this form to register as a volunteer with Arts 4 Dementia.

Your details

First Name: __________________________________________________ 

Last Name:  __________________________________________________

Date of Birth: _________________________________________________

Email: _______________________________________________________

Mobile: ______________________________________________________

Home Address: ________________________________________________

_____________________________________________________________

Your University/College _________________________________________ 

Subject  ______________________________________________________

Would you like Arts 4 Dementia to notify your college about your volunteering with us?   Yes     No

If Yes, please enter your student ID number:  _________________________

Experience

Your special skills:

Art       Comedy        Dance       Drama      Music 
    
Photography      Digital Support      Conference     

Fundraising Challenge       Project Management     

Social Media          College Arts 4 Dementia rep      

  Arts 4 Dementia intern

 

Previous volunteering experience and/or training:

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

Work experience (if applicable)

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

 

What would you like to volunteer for Arts 4 Dementia and
what do you hope to gain from the experience?

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

 

Which areas of volunteering are you interested in?

Art       Comedy      Dance      Drama      Music      

Photography      Digital Support       Conference      Editorial     

Fundraising Challenge     ☐ Project Management       Social Media

College Arts 4 Dementia rep      ☐ Arts 4 Dementia intern

 

Your Availability

Please state when you are available to volunteer:

September 2011      October 2011      November 2011     

December 2011       January 2012      February 2012    

March 2012     April 2012      May 2012      June 2012     

July 2012       August 2012       September 2012        

October 2012      November 2012      December 2012


Your Special Requirements

Please state your special needs, requirements, disabilities (if not applicable, leave blank):

___________________________________________________________________________________

___________________________________________________________________________________ 

Thank you for your interest in Arts 4 Dementia. 


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Contact Us

Arts 4 Dementia
Phoenix Yard
65 King's Cross Road
London
WC1X 9LW

Telephone: 020 7239 4954
Email: info@arts4dementia.org.uk

Registered Company No: 7511427
Registered Charity No: 1140842

Support Us

Find out how you can help

and thanks to…

Our sponsor: Besso

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