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Equal Opportunities
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Home Address:*
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Contact Number:*
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Disability:
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Date of Birth:* DD/MM/YY
(Questions marked * are required)
Female Rathernot say
NoYes Rathernot say
Male
The United Reformed Church39 Convent StreetSwansea - SA1 2BX
Contact: [email protected]
Contact Number:Relationship:
How did you hear about the Unity in Diversity Group?
Volunteer Registration Form
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Are you: community member asylum seeker refugee
Name:Next of Kin
How would you describe yourself?Choose ONE section from A to E, and then tick the appropriate box
Declaration:
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Prefer not to say
BritishEnglishIrishScottishWelshAny other White background, please write in box
Asian or Asian British
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Mixed Heritage
White
White and AsianWhite and Black AfricanWhite and Black CaribbeanAny other Mixed background, please write in box
ChineseAny other, please write in box
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A
B
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D
E
F
BangladeshiIndianPakistaniAny other Asian background, please write in box
Participant Signature:* Date:* DD/MM/YY
Date:* DD/MM/YYStaff Signature:*
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