We’d love you to join us as a volunteer! Name of Therapist*Address* Street Address Address Line 2 City County ZIP / Postal Code Telephone*TelephoneEmail* Regional Team Applied For*Preferred Centre*Right To work UK?*yesnoAny Unspent Convictions?*yesnoCurrent DBS Check?*yesnoMust Be Seen By EASFirst Aid Trained*yesnoMust Be Seen By EASInsurance Held on FileyesMust Be Seen By EASPrimary Healing Skill*Date of CertificationYears Practical ExperienceSecondary Healing*Date of CertificationYears Practical ExperienceOther Healing Skill*Date of CertificationYears Practical ExperienceAvailability*Declaration* I here by declare that this information is true and correct EmailThis field is for validation purposes and should be left unchanged.