FOREST PULSE VOLUNTEER APPLICATION FORM

TO COMPLY WITH OFSTED REGISTRATION (DC2 Equivalent)
(Please complete in block capitals using black or blue ink)

To be completed by every person that is to look after children and young adults at any activity.

Organised by:  Forest Pulse, c/o Heart of the Forest Community Special School, Speech House, Coleford, Glos GL16 7EJ.

Volunteer Details

Title:    Mr / Mrs / Miss / Ms / Other (please specify) ..................................................................

First Names (in full)                                        .............................................................................

Surname                                                          ...........................................................................

Surname at birth if different from above        ..............................................................................

Date of Birth                                                   ........................................   Age ...........................     

Sex                                                                  Male / Female (delete as appropriate)

Address                                                           .............................................................................

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Postcode                                                         .............................................................................

Home Telephone Number                               ..............................................................................

Mobile Telephone Number                             ...............................................................................

Email Address                                                            ...................................................................

Parental name and contact tel number            .............................................................................
(if under 18)

Please give details of any other addresses over the last five years on the reverse of this form.

Doctor's Name / Tel No                      .........................................................................................

Relevant Medical History                   .........................................................................................

Known Allergies (e.g. to medication) .........................................................................................

 

School / College (if applicable)           .........................................................................................

Details of Current Employment          ..........................................................................................
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Experience of working with children, or people with disabilities  ..............................................
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References:  Please give name and address of two people from whom references may be obtained:-
(Tutors/Teachers can be used for volunteers in full-time education).

1)         ..............................................................          2)      .....................................................
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Declaration (please answer all questions)
Have you ever (please tick):
Yes      No
1.         Had an order made against you removing any child from your care?                                   
2.         Had registration as a childminder or as a provider of day care for
under eights refused or cancelled?                                                                            
3.         Had your rights and duties with respect to any child vested in a Local
Authority or court?  (e.g. care, wardship proceedings)                                                         
4.         Had a prohibition relating to fostering imposed on you?                                          
5.         Been disqualified from acting as a foster parent?                                                     
6.         Been involved as an owner or manager of, or had a financial interest
in, a voluntary or registered home for adults or children whose
registration has been refused or cancelled?                                                               

If you have answered 'yes' to any of the above questions, please supply the dates, circumstances, outcomes and the name of the local authority area in which you were living.  If social services departments from other local authorities were involved please also provide their names in the space below.
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Criminal Convictions
Have you ever been convicted of any criminal offences?                                          Yes      No
Please note that this is a position exempt from the Rehabilitation of Offenders Act 1974 and you must include details of spent convictions

 

If you have answered 'yes' to the above question, please supply the following details below:-
a)         date of offence
b)         nature of offence
c)         the place where it occurred
d)         the name of the court which gave the conviction
e)         the penalty imposed, including length of any sentence, fine, probation or order imposed etc
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I am willing to have a check through the Criminal Records Bureau                   YES/NO  
(note we will obtain further permission/information before starting a check)

Consent

I understand that OFSTED may undertake checks with:
a)         Directors of social services (social service records, child protection register)
b)         A General Practitioner or other medical professionals (including a second medical opinion             by a medical practitioner appointed on behalf of OFSTED, if necessary)            
c)         Chief Police Officers / Criminal Records Bureau, including details of spent convictions     exempt from the Rehabilitation of Offenders Act 1974
d)         Protection of Children Act list and Department for Education and Skills List 99
e)         Referees
f)         Previous employers
g)         The Registered Homes List

OFSTED may also check other organisations where OFSTED believes it to be necessary in order to reach an opinion as to the suitability of an individual, including the NSPCC, the probation service and with the electoral roll.

I give consent for any information found in the process of these checks to be shared with OFSTED.  I also give consent for OFSTED to verify any information that may be revealed in the course of their enquiries with appropriate authorities / persons.  I understand that this information is being obtained in connection with the registration of Forest Pulse and I consent to any information obtained being shared with that organisation.

I declare that all the information I have given on this application form is true to the best of my knowledge and belief.
I understand that the registration concerned may be refused or cancelled if I have given false information or have withheld relevant details.
A person who, in an application under section 79E of Part XA of the Children Act 1989, knowingly makes a statement which is false or misleading shall be guilty of an offence and liable, on summary conviction, to a fine not exceeding level 5 on the standard scale.
I understand that OFSTED will provide details contained in the application, and other registration details, to the Department for Education and Skills (DfES) and other government and local authority agencies as required (these details may include information about any enforcement action which OFSTED may take).  DfES requires OFSTED to provide these details to help local authority

 

agencies such as the Early Years Development and Childcare Partnership and the Children's Information Service to organise information, training and advice services for parents and providers.

 

I agree that I have read and understood all parts of this section, and I agree for my contact details to be included on the Forest Pulse volunteer database.                                     

Signed             ..................................................................................

Print Name      ..................................................................................

Date               ..................................................................................

 

 

For office use only

References taken up by Forest Pulse       

 

Reference 1                                                        Reference 2

Taken up by ……………………………………     Taken up by …………………………………...

Date ……………………………………………       Date ……………………………………………

Verbal / Written                                                   Verbal / Written

Details ………………………………………….       Details …………………………………………

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