Active Minds Application

Active Minds Application Form

If you are between 16 and 25 and interested in applying for the scheme, please complete this application and click on submit to send it to us

"*" indicates required fields

Name*

First Last

Address*

Street Address Address Line 2 City Post Code

Phone*

Email*

Enter Email Confirm Email

Date of birth*

Known medical conditions or allergies

Emergency contact name*

First Last

Emergency contact phone*

Relationship*

Why do you want to be involved?*

Why do you want to be part of ‘Active Minds” at Penistone FM?

COVID impact

How has covid impacted on your social life and hobbies?

In the last 18 months

Have you suffered with any of these (tick all that apply)

Loneliness / Isolation

Bereavement

Anxiety and / or depression

Low self-esteem

Help*

Do you need any additional support to attend? Please type N/A if this doesn’t apply to you

Confirmation Name*

Penistone FM Community Radio is committed to processing information in accordance with the General Data Protection Regulation (GDPR). All of the information collected in this form is necessary and relevant to the position of a volunteer within Penistone FM Community Radio. We will treat all personal information with the upmost confidentiality and in line with current data protection legislation. The personal data collected on this form will be held securely and will only be used for administrative purposes. You have the right to request to see a copy of the information we hold about you and to request corrections or deletions of the information that is no longer required. I confirm that the information provided is correct and true to my knowledge and understanding.

Confirmation Date*

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Thank you for completing the expression of interest form.

Comments

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