Every item that has an * must be filled out. There are drop down menus for some items.
Section 1 - Contact Information
Section 2 - RolesRoles below in drop down menu are urgently needed. Please tell us your 1st choice & if you’re willing to do a 2nd or 3rd role. If none of these interest you, there are additional roles listed below. Please take note of days and times listed with each role


Please indicate your interest below, if any. Be selective and only indicate 2-3 choices at most:
Roles Available Monday to Friday 9am-5pm ONLY:
These Roles are Occasional, Evenings & Weekends:
Section 3 - Availablity Your availability should only be selected based on the roles chosen. If multiple roles are selected, please select any time you are available to volunteer, based on the roles
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Section 4 - About you


How did you hear about SCHC?
Section 5 - About volunteering
Section 6 - Experience & Limitations
Have you had work or volunteer experience:











Section 7 - Emergency Contact
Section 8 - ReferencesReferences must be provided - 2 please. Do not use relatives.
Section 9 - Consent

Information collected on this authorized form complies with the Privacy Act and Personal Health Information Protection Act. SCHC collects information to assist with program planning, improvement of services, and research. This information is confidential and shall not be used for purposes other than those for which it was collected, nor shall any identifying information be sent externally, except with your expressed consent or as required by law. We encourage you to discuss any questions you may have with one of our staff. By checking the box above you are verifying that the information provided is true and complete. You give us permission to obtain personal information from your listed references. False statements and omissions are grounds to terminate the volunteer role. I agree to follow SCHC policies & procedures. Failure to do so will result in termination of the volunteer role.
Section 10 - For Hospice Home Visiting, Friendly Visiting, Bereavement Care & Caregiver Support roles









Do you have any training or education in:





To help us with matching you with a service user, please tell us a bit about yourself*


What are your hobbies/interests? (e.g. sports, music, crafts, board games). Please check all that apply.

Willing to visit a client: