Volunteer Application

Last Name
First Name

Address

City
Province
Postal Code

Email

Emergency Contact Name
Emergency Contact Phone

Preferred Name
Home Phone
Mobile Phone
Business Phone
Fax

Skills

Occupation
Education
Special Training

Hobbies and Interests

References

Name
Relationship (not related)
Email
Telephone
Best Time to Contact a.m.p.m.

Please Select Your Property

Kensington VillageEarls Court VillageSaugeen Valley NursingBonnie BraeTyndall Nursing HomesStrathcona Seniors Condos

Preferred Times Available

	Morning	Afternoon	Evening
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Preferred Volunteer Activity

If Other then Provide Description
Reasons for Volunteering
Previous Volunteer Experience
I will commit to:8 Months1 Year Other :

Authorization and Release

Any information received during my volunteer period concerning the personal, financial or other private affairs of the consumer(s) of Sharon Village Care Homes will be treated by me in strict confidence and will not be divulged.

I also understand that the information that I have provided in this Volunteer Application will be verified by Sharon Village Care Homes. I hereby grant permission to Sharon Village Care Homes to contact any persons who might be able to verify the information.

The confidential information on this form is collected under the Health Protection and Promotion Act, R.S.O. 1990, c.H.7 and will be maintained on file. This information will be used for volunteer program planning purposes.

Signature
Date

Volunteer Application

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