Name:

Address:

Phone Number:	Mobile Phone Number:

Email:

How much time can you offer to the Suter Art Gallery?

Days each week:	Days each month:

What times are you available?

Monday am/pm	Tuesday am/pm	Wednesday am/pm	Thursday am/pm	Friday am/pm	Saturday am/pm	Sunday am/pm

Have you worked as a Volunteer in the past, what experience can you bring as a Volunteer?

Please provide an emergency contact:

Name:
Contact number:

Please provide a referee:

Name:
Contact number:

Do you have any health issues that might affect your helping us?

Are you happy for your email / phone number to be shared with Suter Staff and other Volunteers? Yes / No

Are you willing to undertake a Police Vetting/ Criminal records check? Yes / No

Signed:	Date: