Working Retreat at Rookhow

Volunteer information

First and last name *

Preferred name

Pronoun(s)

Gender

Date of birth *

Email *

Address *

Address line 2 (optional)

City *

County/State *

Post/Zip Code *

Country * none selected Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Ascension Island Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Côte D'Ivoire Cambodia Cameroon Canada Cape Verde Caribbean Netherlands Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Cook Islands Costa Rica Croatia Cuba Curaçao Cyprus Czech Republic Democratic People's Republic of Korea Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador England Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands 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 & McDonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar(Burma) Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Ireland Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Republic of the Congo Romania Russia Rwanda Réunion Réunion Sào Tomé And Príncipe Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Saudi Arabia Scotland Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia & South Sandwich Islands South Korea South Sudan Spain Sri Lanka St. Barthélemy St. Helena St. Martin St. Pierre & Miquelon Sudan Suriname Svalbard & Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks & Caicos Islands Tuvalu U.S. Outlying Islands US Virgin Islands Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican Venezuela Vietnam Wales Wallis & Futuna Western Sahara Yemen Zambia Zimbabwe Åland Islands

Mobile phone *

About you

Are you connected to a Quaker community? If yes, please provide the name of the Local and Area Meeting or other Quaker community that you are connected to. *

Why are you interested in coming to this Working Retreat? *

We spend time doing practical work that helps to maintain our host venue. Please describe any relevant skills or experience you may have. *

We prefer to use email to save expense and paper. If you need correspondence sent by post, tick here.

Support and first aid

Allergies and dietary requirements

Health information

Any additional personal information

General practitioner (GP/doctor contact) *

Emergency contact information

Emergency contact full name *

Relationship to you *

Emergency contact mobile number (inc. country code, e.g. +44 for UK) *

Emergency contact email address *

Financial

We want to make sure that everyone can take part in a QVA retreat, regardless of their financial status. Our tiered fee system means you can pay what you can afford, and you never have to justify which tier you choose.

About the fees The fees reflect the approximate cost per person for their time at the retreat including food, accommodation, activities, and resources, plus the costs of running the retreat including facilitator fees and training costs, as well as staff planning and administration costs.

Financial support Help is available if you cannot afford to pay the lower tier of fees. We can support you to apply to your Local / Area Quaker Meeting, Quaker grant-giving trust, or other source of funding. We also have our own Bursary Fund. Please contact us for more information. You never need to justify asking for financial help.

Donations You are extremely welcome to make a donation in excess of the tier 3 fee to support our Bursary Fund and help others take part in QVA retreats. Please visit the Donate page to make a donation.

Please indicate how you intend to pay the fee. * Bank transfer
Cheque
Local/Area/Yearly Meeting funded
Contact me about bursary funding
To be confirmed

Please select which fee tier you will be paying * Tier 1
Tier 2
Tier 3
Bursary

Photo consent

We'd be grateful if the volunteer can be included in photographs/media that may be used for our own future publicity materials and for any externally produced media (For example: The Friend magazine).

If you select no, you must send us a photo of your face so that we can identify you in the pictures and ensure that we do not include any photos that include you by accident in our publicity

Photo and multimedia consent * Yes, I give consent for photos and media
No, I do not give consent for any photos or media

Future contact

Subscribe me to the mailing list Select ... Yes, I'm happy to hear about future retreats and would like to subscribe to QVA's monthly newsletter

Questionnaire

Are you... (select all that apply) * A previous QVA participant
A QVA Trustee/staff member
Attending for the first time
Other (please describe)

Other

How did you hear about the Working Retreat? (select all that apply) * The QVA newsletter
My Local / Area / Monthly Quaker Meeting
An advert / article / letter in The Friend
QVA social media
Young adult Quaker group
At the Britain Yearly Meeting Groups Fair
Online search
Other (please describe)

Other

And finally...

By completing the application form, you agree for us to securely store the information you have provided to help us plan for the event. We will only retain your personal information for as long as is necessary to fulfil the purposes we collected it for, including for the purposes of satisfying any legal, accounting, or reporting requirements. You can request a copy of your information which we hold or ask for any information we have to be deleted by contacting us.

Any comments on the form?

I consent to my submitted data being collected and stored as outlined by the site .