11-13 Chapel Street, Glossop, Derbyshire, SK13 8AT

+44 1457 852621 ccprojectuk@gmail.com www.chernobyl-children.org.uk

Holiday Camp Volunteer Application Form 2012

1. Please complete this form carefully and fully, referring to the role description and
personal specification (even if you have volunteered at the holiday camp before).

2. The deadline for submitting your form is Friday 16th March and you will be informed by
the end of March whether you have been accepted* This year we are planning 3 groups
of 8 volunteers.

3. On acceptance you should attend a training/social residential near Buxton in May (date
to be confirmed shortly). This is compulsory (and fun!) Accommodation free but a small
contribution to food welcome! More details online.

4. You must raise 450 to cover your flight and accommodation at the camp. If you can
raise more than this, fantastic! The extra funds will be used to sponsor a holiday for a
disabled young person living in an institution in Belarus.

5. Please note that this role requires you to be subject to a Criminal Records Bureau
Enhanced Disclosure.

6. The childrens holiday will be for just over three weeks in the period between 18th July
and 19th August. Volunteers are expected to spend about 12 days in Belarus.

7. The details provided on this form will not be disclosed to any third party unless required
to do so by law.

Contact details

Full Name

Email address

Mobile

Chernobyl Childrens Project (UK) is a Registered Charity No. 1059832, and a non profit making company, limited by guarantee.
Registration No. 322045 (England and Wales). Registered office: Kinder House, Fitzalan Street, Glossop, Derbyshire, SK13 7DL
Date of Birth

Address (term time)

Please indicate which address
we should use for
correspondence

Address (permanent)

Gender

Do you have any access

requirement?

How did you find out

about volunteering for
CCP (UK)?

Occupation

Place of Work/Study

Position/Course

*applications after the deadline will only be considered if spaces are still available

Experience

Have you volunteered at

the Holiday Camp before?

Chernobyl Childrens Project (UK) is a Registered Charity No. 1059832, and a non profit making company, limited by guarantee.
Registration No. 322045 (England and Wales). Registered office: Kinder House, Fitzalan Street, Glossop, Derbyshire, SK13 7DL
If so, when?

What experience do you

have, paid or voluntary,

which is relevant to this

role?

Do you have any

experience assisting

people with personal

care?

Do you feel this is

something you might be

prepared to do if given

adequate training?

Aside from experience,

what do you feel you

could personally contribute

to the childrens holiday

and the team of

volunteers?

Chernobyl Childrens Project (UK) is a Registered Charity No. 1059832, and a non profit making company, limited by guarantee.
Registration No. 322045 (England and Wales). Registered office: Kinder House, Fitzalan Street, Glossop, Derbyshire, SK13 7DL
Do you speak any

Russian? (this is not a

prerequisite for the role)

Please tell us on which

dates you will NOT be

available between July

18th to August 19th 2012

Please give the names

and contact details of two

people who have known

you for some time (not

relatives) and are willing

to act as referees. If

possible, one should be

from a place of work/study

where you have

volunteered. At least one

should have had contact

in the last two years.

Chernobyl Childrens Project (UK) is a Registered Charity No. 1059832, and a non profit making company, limited by guarantee.
Registration No. 322045 (England and Wales). Registered office: Kinder House, Fitzalan Street, Glossop, Derbyshire, SK13 7DL
Health Declaration
For Health and Safety reasons, it is important
that we do not assign you the wrong task. A
disability or health problem does not exclude
you from volunteering for us but to assess
your suitability for this role we require
information about your health.

Please describe here any special needs,

disability, allergies or other physical or mental
health matters that may affect your ability to
work as a volunteer that we should be aware
of.

Next of Kin

Name

Relationship to you

Address

Telephone number

Signed

Date

If you wish to add any additional information which may be relevant, please do so below
or on a separate sheet. Applications should be returned by post or email to:
Linda Walker, Chernobyl Childrens Project (UK), 11-13 Chapel St, Glossop, Derbyshire, SK13 8AT 07966
285581 / 01457 852 621 ccprojectuk@gmail.com

Chernobyl Childrens Project (UK) is a Registered Charity No. 1059832, and a non profit making company, limited by guarantee.
Registration No. 322045 (England and Wales). Registered office: Kinder House, Fitzalan Street, Glossop, Derbyshire, SK13 7DL