Volunteer Application Form Please complete the form below and return it to mel.footprints@gmail.com Please include your email address so that we can reply to advise if it is possible to accommodate your visit. Name: Age (at time of travel) Address Email Address Phone No. Occupation: Next of Kin Name Next of Kin Contact Details: Proposed date of arrival and proposed length of stay Where did you hear about us? Tell us why you’d like to volunteer at Footprints Orphanage? Brief Summary of skills and experience Do you have any special dietary requirements or allergies? Do you have any disability or health problems which the staff at Footprints should be aware of? I understand that I must arrange my own vaccinations and travel insurance prior to travelling I am aware a DBS check may be undertaken prior to travel and that I will have to provide the relevant documentation for the check. I am aware I will require a Visa to enter Kenya

Volunteer Application Form Please complete the form below and return it to mel.footprints@gmail.com Please include your email address so that we can reply to advise if it is possible to accommodate your visit. Rehabilittion of Offenders Act (1974) Because of the nature of the work at Footprints all applicants who wish to visit/volunteer at Footprints must tell us about sentences or convictions that for other purposes would be considered to be ‘spent’ under the provisions of the Act. Applications to visit/volunteer at Footprints are exempt from the provisions of Section 4(2) of the Rehabilitations of Offenders Act 1974, by virtue of the Rehabilitation of Offenders Act (Exemptions) Order 1975. Do you have any criminal records to declare? (this includes; sentence, bind-over, caution, discharge, probation, conviction, reprimand) No Yes Are there any current criminal proceedings or investigations on going against you? No Yes Does your name appear on the Protection of Children Act List? No Yes Does your name appear on the Protection of Vulnerable Adults List? No Yes Are you the subject of a risk of Sexual Harm Order (under the Sexual Offences Act 2003)? No Yes Are you the subject of a Violent Offender Order (under the Criminal Justice and Immigration Act 2008)? No Yes If you have answered yes to any of the questions above, please give details on a separate sheet (attached) All information will be treated in the strictest confidence.   DECLARATION This statement is to be signed by the applicant: Please complete the following declaration and sign it in the appropriate place below. if this declaration is not completed and signed, your application will not be considered. I hereby certify that: • All the information given by me on this form is correct. • All the questions relating to me have been accurate and fully answered. Signed Dated

Volunteer Application Form Please complete the form below and return it to mel.footprints@gmail.com Please include your email address so that we can reply to advise if it is possible to accommodate your visit. Rehabilittion of Offenders Act (1974) Please give details for any of the questions you have answered ‘yes’ within this section of the application form. Signed Dated