St. Joseph’s Lifecare Centre

Name:

Date:

Home Phone:

Work Phone:

Volunteer

High School Student (40hrs)

Co-op Student

Teen Volunteer

Address:

Postal Code:

Email:

Allergies or Medical conditions:

In case of emergency call:

Emergency Phone:

Occupation:

Fields of Study:

Do you have language skills other than English?

Spoken:

Written:

Volunteer Experiences: Dates: Description of Work:

Professional and Community Affiliations:

Experiences and Skills: arts and crafts, music, hobbies, gardening:

What are your personal goals in becoming a volunteer?:

1-1 Visits

Tuck Shop

Recreation Programs

Meal Assistance

Restorative

Hair Salon

Spiritual Care

Morning (9-1)

Afternoon (1-5)

Evening (5-9)

Days of the week:

Yes

No

Reference Name:

Reference Phone:

Reference Name:

Reference Phone:

Volunteer Application