EmailMe Form - Volunteer Your Talent Application Form

Title *

Forename *

Middle Name(s)

Surname *

Home Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Home Telephone Number

Mobile Telephone Number

Email *

Date Of Birth *

DD / MM / YYYY

*Some events are age-restricted.

Do you have your own transportation (e.g. a car)? *

Yes

No

Do you object to working in the presence of Smokers, or in the presence of people drinking Alcohol? *

Neither of these are a problem for me; I'm happy to be in the presence of both drinkers and smokers.

Yes I object, I do not want to be around cigarettes and/or alcohol.

I'm ok with alcohol, but I do not want to be in the presence of cigarettes/vaping.

I'm ok with cigarettes/vaping, but I do not want to be in the presence of alcohol.

*Some events are held outdoors and host their own bar (or are on the grounds of a pub or nightclub); consequently, during certain events you're likely to be surrounded by people drinking and/or smoking; if this is a problem, don't worry! There are still various other events which may be more suitable for you.

Do you have a Criminal Record check (CRB/DBS)? *

Yes

No

*Required for certain events with children or vulnerable people.

Name of Business/Act/Performance/Band, etc *

Type Of Talent *

Music, Dancing, Magic, Sculpting, Juggling, Comedy, Massage, Hairdressing, etc

Genre

Rock, Pop, Reggae, Alternative, Modern, Traditional, etc

Your Websites (if any)

Official URL
Facebook
Twitter
Instagram
Linked-In
Flickr
Other

Full list of members (names & what they do)...

(including those behind-the-scenes; such as sound engineers, assistant, etc)

Are any of your members under the age of 21? *

Yes

No

*Please note that some events (not all) are age-restricted, and you may be required to bring proof of identification on the day, especially if you look under 21.

Please give us a brief description of what you will do and what we can expect *

Do you require electricity? *

Yes

No

Do you have Public Liability Insurance? *

Yes

No

*Required for some venues.

State days you are available to volunteer your time... (LippyArt will confirm exact dates with you) *

Are you willing to travel out-of-town for an event? *

Yes, I love travelling - any distance is fine by me!

Yes, I love travelling - only short distances though, preferably within my own county / surrounding area.

No, I prefer to stay local to my hometown.

Any other information...?

Would you object to working around animals, such as at zoos or rescue facilities? (e.g. due to allergies, personal beliefs, etc) *

Yes

No

Would you object to volunteeting at events with children? *

Yes

No

Would you object to volunteeting at events with the elderley? *

Yes

No

Would you object to volunteeting at events with physically disabled people? *

Yes

No

Would you object to volunteeting at events with mentally disabled people? *

Yes

No

Do you have any other requirements or concerns which were
not mentioned above?

Please attach a sample of your work (if you have any)

Accepted File Types: PDF, JPG, JPEG, GIF, TIF, PNG, DOC, DOCX, PPT, PPTX, XLS, XLSX, TXT, MP3, MP4, MPG, FLV, AVI, ZIP (Maximum 800MB).

DECLARATION

• I* certify that the information given on this form is correct to the best of my knowledge.
• I understand that I am responsible for all equipment required for the performance*. LippyArt cannot be held responsible for any loss or damage.
• I understand that I am responsible for public safety relating to the performance (e.g. making sure items are secure, there are no trip-hazards, etc). I am legally responsible for any injuries caused by my equipment / performance. If something is pointed out to me as a hazard, I will take measures to make the area as safe as possible.
• I understand that I am responsible for cleaning up after myself and keeping the area tidy.
• I understand & accept that I may appear in Captures*, of which may end up in the Public Domain*. Including LippyArt's own captures, or a third party (e.g. if there is media present). I give LippyArt permission to use captures in which I am present for all required purposes (promotion, public domain, exhibitions, etc). LippyArt respects each performer and will always reference them accordingly (using your performing/business name &/or website; however, if you have a specific preference, please let her know).

*

I agree to all terms listed in this Declaration.

*The name "LippyArt" refers to Leanne Beetham.
*The term "Captures" or "Capture" refers to images/audio/video footage.
*The term "Public Domain" means content viewable by the public (such as online, magazines / newspapers, blogs, television, etc).
*The term "Performance" refers to your business/talent that is being volunteered.
*For the purposes of this agreement - "I", "my", "me" - refers to the individual filling in this application AND all associated members with the performance (e.g. band members, engineers, technical experts, etc).

Signature *

Clear

*If you have any queries regarding this form, please email: forms@lippyart.co.uk

	Yes, Any time	Yes, Daytime	Yes, Evenings/Nighttime	No
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