Community Allotment Application Form

Volunteering role *

Buddy Volunteer (for those who want to support others in the group. Please be aware that this role requires some training and possibly a DBS)

Have a Grow (for those who just want to join in without the commitment of being a buddy or having our own plot)

Lettuce Grow Together (for those who feel isolated or experience a physical or mental health condition or disability)

Your full name *

First Name

Last Name

Do you have any previous gardening experience?

Yes

No

Preferred session *

Do you have a preferred session or one you would most likely attend? Sessions run weekly, except on bank holidays. You do not need to commit to all sessions, and can be flexible with which session you attend.

Tuesdays 10am-12pm

Fridays 10am-12pm

Not sure

Both

Do you have a medical condition, disability, or needs we should be aware of?

Yes

No

Are you able to attend the sessions independently? *

Yes, I don't need assistance or supervision

No, I will bring a trusted person

Are you?

Male

Female

Other

Prefer not to say

Is English your first language?

Yes

No

Do you use WhatsApp and would want to be added to our broadcast channel to receive regular updates about the community allotment?

Yes

No

Maybe

Do you consent to having your photo taken? *

Occasionally, the charity may take photos and videos during a session. Typically, these are used on our social media accounts or in publicity materials. Unless stated below, Walton on Thames Charity has the right to use the photograph(s) and videos resulting from the photo shoot, and any reproductions or adaptions of the photograph(s) for all general purposes in relation to Walton on Thames Charity's work including, without limitation, the right to use them in any publicity materials, books, newspapers, magazine articles and social media.

Yes

No

In accordance with the Data protection Act 2018, by submitting your application you agree that Walton Charity may hold your personal information including names, addresses, e-mail addresses and telephone numbers. If requested your information will also be shared with our insurers but apart from that it will not be shared with other organisations without your prior agreement. You also agree that Walton Charity may contact you about any matter using e-mail, letter, telephone or other media. All personal information held by the charity will be deleted up to 2 years after this agreement has been terminated. *

First Name

Last Name

Date *

MM

DD

YYYY