Voluntary Workers Procedure

Shrewsbury Town Football Club- Mass Decontamination Exercise Volunteer Registration Form

Please complete the form below if you would like to register your interest. The information will be held in accordance with the Data Protection Act 1998 and will not be used for any other purpose. Please can you complete this form and kindly return it to Nicola Wall at Shropshire Council, Emergency Planning Team, Shirehall, Shrewsbury SY2 6ND. Email: [email protected]

Name (please print) : Address (please print) Postcode: Home Telephone no: Mobile Telephone no: Email: Over 18? : Yes or No (please delete one) If not over 18, please I______, parent/guardian consent to [child’s name]- provide consent of ______participating in this exercise and have read and parent/guardian to signed the important information below. participate

IMPORTANT INFORMATION: Please tick to confirm you understand and accept the following and sign below:

 I understand that I am required to wear a swimsuit or shorts and t-shirt that I don’t mind getting wet, beneath my clothing in order to enter the decontamination unit.

 I understand that I need to bring a towel with me and a spare change of clothes.

Signed:______

Name:______

Date:______

STFC Exercise Volunteer Form 1 Do you have any health related issues that Shropshire County Council needs to be aware of e.g. allergies? Yes / No. If yes, please state:

Do you need to tell us about any medication you are taking? Yes / No If yes, please state:

Do you have your own transport? Yes/No Do you have business use (class 1) on your insurance? Yes/No Do you have a driving licence? Yes/No

Contact details for next of kin / nominated person in case of emergency. Name: Address: Telephone Number:

DECLARATION Finally, when you sign this form you acknowledge that as a volunteer you represent Shropshire Council and will conduct your work in an appropriate professional manner according to the instructions you are given.

Signed: ……………………………………………… Date: …………………

STFC Exercise Volunteer Form 2