Thank you for your interest in becoming a Youth Volunteer with Popham Kidney Support.

The Youth Volunteer Programme is an exciting opportunity to develop new skills, build confidence, meet other young people, and help shape the support and activities we offer to children and young people affected by kidney disease.

Please complete this form as fully as possible. If you are under 16 years of age, a parent or guardian will need to complete the consent section at the end of the form.

PKS is a registered charity no. 1160114
About You

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1. Full Name

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2. Date of Birth

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3. Age

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4. Address

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5. Postcode

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6. Mobile Number

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8. Preferred Method of Contact

About Your Experience

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9. Tell us a little bit about yourself and your Kidney Disease journey

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10. What activities, hobbies or interests do you enjoy?

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11. Have you attended any Popham Kidney Support activities, events or residentials?

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12. If yes, please tell us which ones:

Becoming a Youth Volunteer

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13. Why would you like to become a Youth Volunteer with Popham Kidney Support?

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14. What do you hope to gain from the programme?

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15. What skills or qualities do you think you could bring to the Youth Volunteer team?

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16. Which opportunities would interest you most? (Select all that apply)

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17. What would being a Youth Volunteer mean to you?

Availability

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18. Are you able to commit to:
Weekly online sessions?

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19. One face-to-face meeting each month?

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20. Are there any dates, times or commitments we should be aware of?

Support Requirements

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21. Do you have any support needs, accessibility requirements, or medical information that would help us support your participation?

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22. Is there anything else you would like us to know?

Emergency Contact

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23. Emergency Contact Name

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24. Telephone Number

Applicant Declaration

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26. I confirm that the information provided is accurate to the best of my knowledge.

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27. I understand that participation in the Youth Volunteer Programme requires respectful behaviour and active engagement.

Parent/Guardian Consent (Applicants Under 16)

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28. Is the applicant under 16 years old?

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29. Parent/Guardian Name

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30. Telephone Number

Consent

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32. I confirm that I am the parent/guardian of the applicant.

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33. I give permission for them to participate in the Popham Kidney Support Youth Volunteer Programme.

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34. I understand that the programme involves weekly online sessions and monthly face-to-face meetings.

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35. I consent to Popham Kidney Support communicating directly with my child regarding programme activities.

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36. I understand that all activities will be delivered in line with Popham Kidney Support safeguarding policies.

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37. Parent/Guardian Signature (Type Full Name)

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38. Date

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