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? You may communicate with me by email from time to time about the Residence. I understand that the Residence respects my privacy, and I can unsubscribe at any time. Yes No Submit
