Volunteer form Name First name * Last name * Email * Confirm Email * Mobile number * Hours per week you are able to vounteer Do you use the services of ADHD Embrace? Yes No Address * Address line two London council borough * Not in London borough Richmond upon Thames Kingston upon Thames Barking and Dagenham Barnet Bexley Brent Bromley Camden Croydon Ealing Enfield Greenwich Hackney Hammersmith and Fulham Haringey Harrow Havering Hillingdon Hounslow Islington Kensington and Chelsea Lambeth Lewisham Merton Newham Redbridge Southwark Sutton Tower Hamlets Waltham Forest Wandsworth Westminster If in London, please select your borough County council * Not in the UK Greater London Bath and North East Somerset Bedfordshire Berkshire Bristol Aberdeenshire Angus Antrim Argyll & Bute Ayrshire Banffshire Armagh Berwickshire Blaenau Gwent Borders Bridgend Buckinghamshire Caerphilly Caithness Cambridgeshire Cardiff Carmarthenshire Ceredigion Cheshire Clackmannanshire Conwy Cornwall County Durham Cumbria Denbighshire Derbyshire Devon Down Dumfries & Galloway Dunbartonshire East Ayrshire East Dunbartonshire East Lothian East Renfrewshire East Riding of Yorkshire East Sussex Essex Fermanagh Fife Flintshire Gloucestershire Greater Manchester Gwynedd Hampshire Herefordshire Hertfordshire Highland Inverclyde Isle of Anglesey Isle of Wight Isles of Scilly Kent Kincardineshire Lancashire Leicestershire Lincolnshire Londonderry Merseyside Merthyr Tydfil Midlothian Monmouthshire Moray Neath Port Talbot Newport Norfolk North Ayrshire North Lanarkshire North Somerset North Yorkshire Northamptonshire Northumberland Nottinghamshire Orkney Oxfordshire Pembrokeshire Perth & KInross Powy Renfrewshire Rhondda Cynon Taff Rutland Shetland Shropshire Somerset South Ayrshire South Gloucestershire South Lanarkshire South Yorkshire Staffordshire Stirlingshire Suffolk Surrey Swansea Torfaen Tyne & Wear Tyrone Vale of Glamorgan Warwickshire West Dunbartonshire West Lothian West Midlands West Sussex West Yorkshire Western Isles Wiltshire Worcestershire Wrexham If outside London, please select your area Full Postcode * Please include a space in UK postcodes Country * United Kingdom Afghanistan Åland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Saint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo, Republic of the Congo, The Democratic Republic of the Cook Islands Costa Rica Côte d’Ivoire Croatia Cuba Curaçao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran, Islamic Republic of Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea, Democratic People's Republic of Korea, Republic of Kosovo Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Macedonia Northern Mariana Islands Norway Oman Pakistan Palau Palestine, State of Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Barthélemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Serbia and Montenegro Seychelles Sierra Leone Singapore Sint Maarten (Dutch Part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania, United Republic of Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Health and Disability Do you have any disabilities, support or health needs we should be aware of? * Yes No The Disability Discrimination Act 1995 defines a person as disabled if they have a mental or physical impairment which has a substantial and long term adverse effect on one's ability to carry out normal day to day activities. Do you have any disabilities, support or health needs we should be aware of? Emergency contact number * Emergency contact name Subscribre to our newsletter I would like to receive the fortnightly newsletter Policies and guidelines I have read and will follow the ADHD Embrace's safeguarding policy document * Yes No I have read and will follow the ADHD Embrace's volunteers guidelines * Yes No Signed * Please type your name in lieu of a signature