Community Allotment Application Form

SECTION 1 – Tell us about yourself

Your full name

First Name

Last Name

Current address & postcode

Telephone Number

Telephone Number (mobile)

Email address

SECTION 2 – EMERGENCY CONTACT DETAILS

Person 1 / Name

Address

Telephone Numbers

How does this person know you?

Person 2 / Name

Address

Telephone Numbers

How does this person know you?

Background Knowledge/Experience

Do you have any previous gardening experience?

YES

Please tell us what you hope to gain from volunteering on the Community Allotment:

Employment Status:

Employed

Retired

Student

Looking after family/home

Job seeker

Unable to work

How did you hear about the Community Allotment?

Do you have a medical condition, disability, or needs we should be aware of?

Yes

If “Yes” please give us brief details

Are you?

Male

Female

Other

Prefer not to say

Please tell us your age

Is English your first language?

Yes

Please click the SUBMIT button below OR return your completed form to: Community Allotment Project, Walton Charity, 1 & 2 The Quintet, Churchfield Road, Walton on Thames, KT12 2TZ

In accordance with the Data protection Act 2018, by submitting your application you agree that Walton Charity may hold your personal information including names, addresses, e-mail addresses and telephone numbers. If requested your information will also be shared with our insurers but apart from that it will not be shared with other organisations without your prior agreement. You also agree that Walton Charity may contact you about any matter using e-mail, letter, telephone or other media. All personal information held by the charity will be deleted up to 2 years after this agreement has been terminated.

First Name

Last Name

Date

YYYY

I understand that should I wish to help children, young persons or vulnerable people, then it will usually be necessary to apply for disclosure of any information held at the Disclosure and Barring Service.
I hereby grant Walton on Thames Charity the right to use the photograph(s) resulting from the photo shoot, and any reproductions or adaptations of the photograph(s) for all general purposes in relation to Walton on Thames Charity’s work including, without limitation, the right to use them in any publicity materials, books, newspapers, magazine articles and social media whenever Walton on Thames Charity chooses to do so.