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Who we are
Trustees
Senior Management Team
Key Facts
History
Our Services
Inpatient Unit
Care In Your Home
Day Hospice/ Integrative Care Clinic
Child and Young Person Bereavement Support
Adult Bereavement Support
Patient Services
Compassionate Communities
Get Involved
Volunteering
In Memory Meadow
Corporate Volunteering
Legacies
Make a Will
Fundraising
Donate now and make a difference
Weekly Draw
Run a Marathon for Foyle Hospice
Organise an Event
Coin Hunt
Giving in Celebration
Events
Our Shops
Vacancies
donate
Who We Are
Who we are
Trustees
Senior Management Team
Key Facts
History
Our Services
Our Services
Inpatient Unit
Care In Your Home
Child and Young Person Bereavement Support
Day Hospice Draft
Adult Bereavement Support
Patient Services
Get Involved
Get Involved
Vacancies
Volunteering
Corporate Volunteering
Fundraising
Fundraising
Donate now and make a difference
Weekly Draw
Organise an Event
Coin Hunt
Giving in Celebration
Legacies
Make A Will
Events
Our Shops
Fundraise For Us
Dedicate a Flower
News
Shop
Contact
My Account
Volunteer Enrolement Form
Personal Details
Name
First
Last
Address
Street Address
Address Line 2
City
County / State / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Phone Number
Email
(Required)
Age
18 years +
16-17 years
Health Statement (please indicate if you have any health problems or a disability we would need to know)
Please tell us if you have been bereaved in the last 12 months
Yes
No
Person to contact in case of emergency
Relationship to you and Contact Number
Current Status
Current Status
Employed
Unemployed
Student
Retired
Other (Please specify below)
Further comment
Skills & Experience
Please tell us about your skills, previous experience and hobbies
Experience of Volunteer Work
Please tell us of any previous and/or current volunteer activities you have experience of.
Please select which areas you are interested in Volunteering:
Day Hospice
Fundraising Department
Retail Shops
Please tell us why your are interested in Volunteering for Foyle Hospice.
Please note if you feel there is any other way in which you feel you could make a contribution.
Commitment
Please let us know what availability you have for volunteering. If you able to give an indication of times, please note them in the boxes below ie. Tuesday 9.00am - 1.00pm
Monday
Morning
Afternoon
Evening
Tuesday
Morning
Afternoon
Evening
Wednesday
Wednesday
Morning
Afternoon
Evening
Thursday
Morning
Afternoon
Evening
Friday
Morning
Afternoon
Evening
Saturday
Morning
Afternoon
Evening
Sunday
Morning
Afternoon
Evening
References
Please provide details of two references who can be contacted as a reference. Please note your references must not be a family member and must be over 18 years of age. Please provide their name, address, telephone and email address.
Rehabilitation of Offenders (Exceptions_ Order NI 1979)
Failure to disclose could result in you being asked to leave your volunteering role in Foyle Hospice.
Do you have any criminal convictions?
Yes
No
If yes, please give details about all convictions which are regarded as criminal offences.
IT SHOULD BE NOTED THAT DISCLOSURE OF A CONVICTION DOES NOT NECESSARILY IMPEDE YOU FROM VOLUNTEERING
The Hospice Policy on the Recruitment of Ex-Offenders is available at www.foylehospice.com/who-we/are/terms-policies
Access NI Disclosure
Particular volunteer roles within the hospice are exempt from the provision of Section 2 of the above Order. This means that when applying for these roles you should declare any past criminal convictions. As part of the selection process for these roles you will be required to undergo an AccessNI Enhanced Disclosure as per the AccessNI Code of Practice (available at www.nidirect.gov.uk/publications/accessni-code-practice) and Privacy Notice (available at www.justice-ni.gov.uk/publications/ani-privacy) this will disclose ‘spent’ convictions. Due to the nature of volunteer roles carried out within some of the departments within Foyle Hospice, we may have to check the Adults Barr List as part of our enhanced NI Access Check Is there any reason you cannot work in a regulated activity? (Regulated Activity is an activity that you must not do if you are barred from working with children or vulnerable adults)
Is there any reason you cannot work in a regulated activity?
Yes
No
(Regulated Activity is an activity that you must not do if you are barred from working with children or vulnerable adults)
If YES, please provide details:
Declaration and Consent
I hereby declare that the information given is correct and agree to my information being processed by Foyle Hospice for the purpose of administration, management and support of volunteers. I shall not during the period of volunteering or at any time thereafter disclose any confidential knowledge or financial information of Foyle Hospice, or any personal information relating to its patients, their families and carers, employees, volunteers or trustees in any manner whatsoever. I hereby consent to my referees being contacted and if relevant an Access NI enhanced check being undertaken by Foyle Hospice.
Untitled
Untitled
Consent
I agree
Date
MM slash DD slash YYYY
Please return to: Rachael Dobbins Volunteer Coordinator Foyle Hospice 61 Culmore Road Derry~Londonderry BT48 8JE Tel No: (028) 7135 1010 E: rachaeldobbins@foylehospice.com
All information provided is treated confidentially and is used only for the purposes of volunteer placement. For further information on the hospice Privacy Notice and the Policy on the Handling, Storage and Disposal of Information is available at www.foylehospice.com/who-we-are/terms-policies
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