Volunteer Application Form

* fields are required

First Name *

Last Name *

Address *

City *

Prov. *

Postal Code *

Telephone - Home *

Telephone - Cell

Telephone - Work

Email Address *

Birthday (month, day) *

Occupation/ Student – year/grade *

Previous employment/ volunteer experience *

Languages - Spoken *

Languages - Written *

Skills you wish to share *

Why do you want to volunteer with Haro Park Centre? *

Who should we contact in the event of an emergency?

Name *

Relationship *

Phone Numbers *

Please list 2 references who are not friends or family. (Note: These individuals will be contacted.)

1. Name *
   

   Email *
   

   How do you know this person? *
   

   Phone *
   

2. Name *
   

   Email *
   

   How do you know this person? *
   

   Phone *
   

Length of commitment *
4 months6 months1 yearOther:

Times Available (Please list, under each day, your available hours, e.g., Tuesdays 12 – 4 pm)

• Mon

• Tue

• Wed

• Thu

• Fri

• Sat

• Sun

Examples of Volunteer Positions: (Please check which ones interest you)
Exercise ClassGardeningSewing/MendingHappy Hour & PubBowling/Shuffleboard“Haro Hut” Concession/Gift ShopChoir/Music Therapy/Sing-AlongRehab AssistantChurch/Fellowship GroupOutingsAdministrationSpecial Events/Entertainment/PartiesOne-to-one visitingTea & Coffee ServicePalliative Care VisitingOther. Please specify:

I HEREBY CERTIFY THAT THE INFORMATION CONTAINED IN THIS APPLICATION IS TRUE TO THE BEST OF MY KNOWLEDGE

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