PERSONAL INFORMATION Name * Address * City * Province * Postal Code * Primary Phone * Alternate Phone Email Address * Age Range * 17 and under 18 and over Emergency Contact * Primary Phone * Alternate Phone Have you ever been convicted of a criminal offence for which a pardon has not been granted? * Yes No ROLE PREFERENCE Please indicate which volunteer role(s) you are most interested in: * Home Visiting Program (Direct Service) Day Hospice (Direct Service) Grief & Bereavement Peer Support (Direct Service) Transportation (Direct Service) Board of Directors Administrative Support Exterior Maintenance Community Education & Outreach Fund Development/Event Coordination Casual Special Events Volunteer (Event Day) Other: AVAILABILITY Please indicate your availability by checking off the boxes below: Sunday Morning Afternoon Evening Monday Morning Afternoon Evening Tuesday Morning Afternoon Evening Wednesday Morning Afternoon Evening Thursday Morning Afternoon Evening Friday Morning Afternoon Evening Saturday Morning Afternoon Evening How would you describe the commitment you are able to make at this time? * EDUCATION & EXPERIENCE Please list any relevant training/education, including dates (e.g. Courses, CPR/First Aid, ASIST, etc.): * Please describe any relevant employment and/or volunteer experience: * I understand that Beth Donovan Hospice reserves the right to decline my application and that the submission of this application does not guarantee my acceptance and placement as a volunteer. I declare that the information contained in this application is complete and accurate to the best of my knowledge and that any false information or misrepresentation may result in my disqualification from the initial screening process and/or my dismissal as a volunteer. * Yes No Submit
