Please complete all relevant sections of this form.

Fields marked with an * are required

By completing the contact information below, you consent to being contacted about volunteering opportunities with Resurgo or their partners.

Your title * Mr. Mrs. Ms. Dr. Prof. Miss Other

First Name *

Last Name *

Phone *

Email *

Your Date of Birth *

What is your ethnic background? (We aim to have a pool of volunteers that reflects the diversity of our trainees) * Asian/Asian British Black/African/Caribbean/Black British Mixed/multiple ethnic groups Other ethnic group White Prefer not to say

Name *

Address *

Telephone *

Relationship to you *

How did you hear about us? * My church partners with the Spear Programme My employer partners with Resurgo Social Media Post Through a family, friend or contact Through a web search Other New Wine

Please give us some more details *

What interests you about volunteering with Resurgo? *

What experience, if any, do you have of working with young people or vulnerable adults? *

Are there any elements of your career story which could inspire a young person? *

What do you hope to gain from volunteering? *

Where you would like to volunteer? * A Spear Centre in London Spear Bournemouth Spear Brighton Spear Leeds Spear Bristol Spear Ipswich Spear Hastings Spear Preston Spear Cheltenham Spear South Wales Spear Gateshead

Which centre in London? (Please note Spear Hammersmith & Fulham is currently oversubscribed) * No preference Spear Bethnal Green Spear Camden Spear Clapham Junction Spear Hammersmith & Fulham Spear Islington Spear Kennington Spear North Kensington

Would you like to receive occasional emails from Resurgo? * yesno

Yes, I would like to receive occasional phone calls from Resurgo

Have you ever been convicted of a criminal offense or cautioned, reprimanded or given a final warning by the police (unspent)? * YesNo

Are you disqualified from working with children or vulnerable/protected adults? * YesNo

Are you aware of any police enquiries following allegations made against you, which may have a bearing on your suitability for the role? * YesNo

If you’ve answered ‘YES’ to any of the above, please give details of all offences, penalties, and/or police enquiries and dates. If you would prefer to discuss this with a member of our team rather than giving details in this box, please indicate this

England and Wales – are you registered with the DBS Update service? YesNo

I agree to the above

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