KickStart Booking Form

Name *

First

Last

Email *

Date of Birth *

Current Situation *

working f/t or p/t in education f/t or p/t not doing anything

National Insurance Number *

Age *

Comments or Questions *

Post code *

Mobile Phone Number *

All referrals to KickStart must be supported by a reference from a worker from another organisation. The worker giving the references must fill in the bottom section of this form. If you don't have someone who can give you this reference you can still join in you just need to fill in a different form so just give us a call on 01458 836130 and we can sort it out.

It is VN’s policy only to take referrals from workers and agencies that disclose all relevant information about individuals, so that we can support them appropriately in their volunteering. This includes health, behaviour, drugs use, history and any other relevant information. By submitting this page you confirm that all information has been declared and that you understand that by failing to disclose information about any form of risk you could potentially be committing a criminal offence under the Health and Safety at Work Act etc 1974.