Please choose the type of membership you want to add below: Full membership Please choose the membership type: GoldSilverStandard First Name (required) Surname (required) MaleFemale Street Address Suburb / Area (required for pickups) Ethnicity / Iwi / Hapu Occupations (Paid and voluntary, past and present) Landline Mobile Email address Preferred Method of Contact MobileTextEmailLandline Languages Age range Under 2526 - 4546 - 6566 - 75Over 75 I can offer support to members / seniors / kaumātua Companionship: reading,playing board games etcAdvocacy: medical benefitsIntroducing members to social events and clubsSupporting people to get out and about and keep fitTeaching Skype, social mediaSorting through photos, recording life storiesSupporting people moving house or tidying up their homeBasic home & garden maintenanceWalking dogs, feeding animalsEnsuring people have an emergency kitSupport to learn to use the bus or a mobility scooterOther I could do with some support with Companionship: reading, playing board games etcAdvocacy: for medical needs or help applying for benefits/grantsFinding / accessing things to do outside my homeSupport to get out and about and keep fitLearning to Skype, use social mediaSorting through photos, recording life storiesSupport when moving house or tidying up homeBasic home & garden maintenanceSomeone to walk my dogs, feed my animalsEmergency kit preparationSupport to learn to use the bus or a mobility scooterOther I can offer skills to EBV organisation Admin, data entryWebsite updatesWriting stories and taking photos of our workSharing information about EBV on your networksSetting up displays and attending market daysVisiting new members to find out what they need and can offerCoordinating responses, answering the phone and emailsOrganising get togethers, meetings, eventsOther Are there other skills you enjoy or might share (eg. arts, craft, music, languages)? Other support I can offer What other things bring you joy (eg. walking, board games, making jam, fishing)? What clubs, church, organisations, marae and networks do you belong to? I can offer intermittent / occasional average of hours a fortnight I can offer regular hours, of an average of hours a fortnight Days & times when I am not free Do you have any preferences for matching members? (eg. age, gender, ethnicity)? How do you move around your community? Do you have access to a vehicle? YesNo Do you have a current full drivers license? YesNo It is helpful if you are able to share the name of someone in your network or family we could contact in case of accident or illness Because we will be supporting vulnerable and isolated older people we have to do police and referee checks, and check your identity by sighting two forms of ID, one of which must have a photograph. You will need to fill out the police check form and also give us the name of a person who can act as a referee. Referees name, phone numbers and addresses (preferably two referees). We would like to have photos of members on our database. If you are willing to have your photo taken or share a photo you already have then let us know. Also are you willing to have a photo on our members' website? If so, please tick this: I am willing to have my photo on the members' website Do you have any disability / support needs? Associate membership First Name (required) Surname (required) MaleFemaleOther Street Address Suburb / Area (required for pickups) Ethnicity / Iwi / Hapu Occupations (Paid and voluntary, past and present) Landline Mobile Email address Preferred Method of Contact MobileTextEmailLandline Languages Age range Under 2526 - 4546 - 6566 - 75Over 75 Support from other members to do the following could enhance my life: Companionship: reading, playing board games etcAdvocacy: for medical needs or help applying for benefits/grantsFinding / accessing things to do outside my homeSupport to get out and about and keep fitLearning to Skype, use social mediaSorting through photos, recording life storiesSupport when moving house or tidying up homeBasic home & garden maintenanceSomeone to walk my dogs, feed my animalsEmergency kit preparationSupport to learn to use the bus or a mobility scooterOther The things I enjoy (or have enjoyed in the past) (eg. arts, craft, music, languages)? What other things bring you joy (eg. walking, board games, making jam, fishing)? What family / whanau support do you have? What clubs, church, organisations, marae and networks do you belong to? How do you move around your community? Do any health or disability issues restrict your mobility or energy? Do you prefer to spend time with members who are male, female, both? MaleFemaleBoth We would like to have photos of members on our database. If you are willing to have your photo taken or share a photo you already have then let us know. Also are you willing to have a photo on our members' website? If so, please tick this: I am willing to have my photo on the members' website Do you have any disability / support needs? Make a Request Request a Service What is your name: What is your email address (the same one used for your membership): What is the first date that the request is needed for? Will this involve ongoing support? YesNoIt depends What service are you after? Skills - learning, sharingIn home visit (companionship, reading, card-playing, sharing time etc)OutingBuilding Social Connections (introducing people to others, clubs etc)Physical ExerciseAdvocacy (medical or suggesting tradespeople, insurance issues other advice)Home/garden maintenanceEmergency planning/support Other: Would you like to add a message? Finished Requests What was the task ID? (optional) What sort of support was offered? Skills - learning, sharingIn home visit (companionship, reading, card-playing, sharing time etc)OutingBuilding Social Connections (introducing people to others, clubs etc)Physical ExerciseAdvocacy (medical or suggesting tradespeople, insurance issues other advice)Home/garden maintenanceEmergency planning/supportNone How many hours were spent on this task, including travel (approximately)? What sort of support was offered to our Eastern Bay Villages organisation? Promotion ( B & L stalls, photography, putting up displays, writing stories for web page staffing office.)Governance (trust meetings and other work trustees do)Enrolling membersInduction and trainingEvents (helping set up, facilitate, register people, food)OtherNone What is your name? (first and surname) What is your email address? (used to log how many hours spent, so we don't overload you!) Any notes you want to add
