Personal Information First Name: Last Name: Address City Province Postal Code Phone Cell Email Languages Spoken English French Other, please specify: Which ancillary service would you like to offer: Hairdressing Manicure Massage Meditation Yoga Other, Please specify: Current Occupation: Are you certified in the service you would like to volunteer? Yes No When did you obtain your certification? Date: From which school? Are you a member of a recognized professional association? Yes No If yes, please specify: Do you have liability insurance? Yes No Do you have any prior volunteer experience? Yes No If yes, please specify: Do you have experience in oncology and/or palliative care? Yes No If yes, please specify: How did you hear about our volunteer program and why do you want to volunteer at the Teresa Dellar Palliative Care Residence? Submit
