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: ________________________________________________
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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:
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Work experience (if applicable)
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What would you like to volunteer for Arts 4 Dementia and
what do you hope to gain from the experience?
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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):
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Thank you for your interest in Arts 4 Dementia.