Please complete all relevant sections of this form.

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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

Which centre in London? * 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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