Alternative text

Volunteer application form

The following information will be kept strictly confidential. Please feel free to add further details on additional paper if necessary.

Do you have any history of psychological difficulties?
Have you ever had or been treated for a psychological condition such as depression, eating disorder, drug/alcohol addiction, anxiety disorder, psychosis, schizophrenia, mania or any other psychological condition or suicidal tendencies. Please describe, specifying condition(s) and date(s).

Are you currently taking medication for any physical or psychological conditions? If yes, please specify the condition and list the medications and dosage

I undertake to follow the guidelines of Moulin de Chaves Association, and I will take full responsibility for myself and my actions during my time here and in any activities of the Association.