OPEN COUNTRY VOLUNTEER APPLICATION FORM
CONFIDENTIAL
Thank you for applying to become a volunteer with Open Country. For the safety and security of yourself
and those you will be helping, we need some information for our records.
Please complete the blank sections below:
Name:
_____________________________________
Address:
_____________________________________
_____________________________________
Postcode:
_____________________________________
Telephone:
_____________________________________
E-mail address:
_____________________________________
 Where did you first hear about us?
____________________________________________________________________________________
 What interests or work experience do you have relevant to Open Country?
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
 Do you have a full, current driving licence?
Yes

No

 As volunteers may work with vulnerable people, we ask for two references from people who have
known you for at least a year. We will write to them to request a written reference.
Please give the names and addresses of two people who can give references for you:
Name
________________________
Name
________________________
Address
________________________
Address
________________________
________________________
________________________
________________________
________________________
Postcode
________________________
Postcode
________________________
Telephone
________________________
Telephone
________________________
Capacity in which you are known:
Capacity in which you are known:
____________________________________
____________________________________
Thank you for filling in this form.
We will be in touch when we have received your references but please feel free to contact either Kate or
David on 01423 507227 if you have any questions.
Open Country, Community House, 46 East Parade, Harrogate, HG 5LT Tel: 01423 507227 Email: info@opencountry.org.uk
Open Country Equal Opportunities and Confidentiality Statement
VOLUNTEERS COPY. PLEASE KEEP THIS COPY FOR YOUR OWN RECORDS.
Equal Opportunities Statement
Open Country strives to provide opportunities for all sections of the community to volunteers on the
various activities organised by the project.
All persons applying to volunteer with Open Country and all accredited volunteers will be given equal
opportunities irrespective of their race, sex, sexual orientation, marital status, any or no religion, home
circumstances or disability.
Open Country works to provide opportunities for people who cannot usually get into the countryside. It
is expected that volunteers will not treat any participant less favourably on the grounds of their race,
sex, sexual orientation, marital status, any or no religion, home circumstances or disability.
Confidentiality Statement
Due to the nature of the activities Open Country organises, it is necessary to have personal information
and relevant medical information about people to ensure their safety and in case of emergency. Activity
leaders are given access to information about participants on the activity they are leading.
All information is treated as confidential unless there is an emergency requiring disclosure to medical
personnel or emergency services.
Due to the social and relaxed nature of Open Country activities, volunteers, may sometimes be told
personal and private details by participants.
Volunteers are expected to respect the confidentiality of people involved in Open Country, and not to
disclose any information to which they are given access, either written or verbal.
In the event that a volunteer is given information which causes concern for someone’s safety to well
being, please notify the Open Country Project Officer as soon as possible. If there is an immediate
concern for someone’s safety, ring the duty social worker for NYCC Social Services Dept.
I have read and understood the above statements.
Date…………………………………………………..
Please print your name…………………………………………………………………………
Please sign your name…………………………………………………………………………..
Open Country Equal Opportunities and Confidentiality Statement
PLEASE SEND THIS COPY BACK TO OPEN COUNTRY WITH YOUR VOLUNTEER APPLICATION FORM. MANY THANKS.
Equal Opportunities Statement
Open Country strives to provide opportunities for all sections of the community to volunteers on the
various activities organised by the project.
All persons applying to volunteer with Open Country and all accredited volunteers will be given equal
opportunities irrespective of their race, sex, sexual orientation, marital status, any or no religion, home
circumstances or disability.
Open Country works to provide opportunities for people who cannot usually get into the countryside. It
is expected that volunteers will not treat any participant less favourably on the grounds of their race,
sex, sexual orientation, marital status, any or no religion, home circumstances or disability.
Confidentiality Statement
Due to the nature of the activities Open Country organises, it is necessary to have personal information
and relevant medical information about people to ensure their safety and in case of emergency. Activity
leaders are given access to information about participants on the activity they are leading.
All information is treated as confidential unless there is an emergency requiring disclosure to medical
personnel or emergency services.
Due to the social and relaxed nature of Open Country activities, volunteers, may sometimes be told
personal and private details by participants.
Volunteers are expected to respect the confidentiality of people involved in Open Country, and not to
disclose any information to which they are given access, either written or verbal.
In the event that a volunteer is given information which causes concern for someone’s safety to well
being, please notify the Open Country Project Officer as soon as possible. If there is an immediate
concern for someone’s safety, ring the duty social worker for NYCC Social Services Dept.
I have read and understood the above statements.
Date…………………………………………………..
Please print your name…………………………………………………………………………
Please sign your name…………………………………………………………………………..