NORTH & SOUTH BERSTEAD, EAST & WEST ALDWICK,

BOGNOR REGIS, PAGHAM,EASTERGATE, WESTERGATE,

FLANSHAM, FELPHAM, MIDDLETON-ON-SEA, ELMER,

ARUNDEL, CLIMPING, YAPTON, BARNHAM

Sussex Neighbourhood Watch Co-ordinator/Street Contact
Registration & Security Consent form
Neighbourhood Watch Co-ordinators/Street Contacts are volunteers in a position of authority and trust. Sussex Police and Neighbourhood Watch have a policy of checking all Co-ordinators/Street Contacts and deputies to verify their identity, and for any previous convictions or other circumstances that would make it inappropriate for them to hold such a position. Any information given will remain confidential. Not all previous convictions will mean automatic disqualification, but the final decision will rest with Sussex Police. You will need to submit a copy of your passport or driving licence, or other official documentation to establish your identity, along with this form.
Please complete in BLOCK CAPITALS the details below.
Title and full name:

Previous surnames used (if applicable):

Date of birth: Place of birth:

Home address:

Post Code:

Home phone: Mobile:

Email Address:

My scheme covers:
I give permission for Sussex Police to perform all necessary background checks. I also give Sussex Police and Neighbourhood Watch authority to place my details on file, in compliance with Data Protection laws, and to use them for policing and Neighbourhood Watch purposes only. I agree to comply with Data Protection laws, and to relinquish my position should circumstances arise or information become available that would be inconsistent with my holding this position of responsibility. I agree to receive community messages from Sussex Police, Action Fraud and Neighbourhood Watch, and where appropriate to forward these to Neighbourhood Watch members in my scheme.

Signed:___________________________________________________ Date:______________________________________________________
Coordinator Registration Form V6 14/4/2018

PLEASE MAKE SURE ALL DETAILS ARE CORRECT BEFORE PRINTING

PLEASE NOTE WHEN FILLED IN,
ALL WORDING BELOW PRINT FORM BUTTON,
WILL NOT BE PRINTED.
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