South Staffordshire Community and Voluntary Action
Database Form 2008
(Please complete sections 1&2 and ensure the form is signed before you return it). Thank you.
SECTION 1
Organisation Name: ...................................................................................................
Contact Name:.............................................................................................................
Organisation Address (Meeting place / where activities take place )
...................................................................................................................................
...................................................................... Post Code ...........................................
OrganisationTel No:....................................... Fax No: ..............................................
Website address: (if applicable) ................................................................................
Registered Charity No: (if applicable) ..........................................................
Opening hours /Day / Time activity takes place: .........................................................
.....................................................................................................................................
Description of activities: ..............................................................................................
......................................................................................................................................
If your organisation works with children and young people please tick appropriate age group: 0-5yrs 6-11yrs 12-16yrs 17-19yrs
SECTION 2
PLEASE NOTE: THE INFORMATION PROVIDED IN SECTION (2) IS FOR SSCVA ADMIN PURPOSES ONLY AND WILL NOT BE RELEASED TO THE PUBLIC OR OTHER ORGANISATIONS.
Contact Name:............................................................................................................
Contact Address: (if different from Section 1)
...................................................................................................................................
..................................................................... Post Code: ..........................................
Tel No: .........................................................
SIGNED:........................................................ DATE: .................................................