Personal Information First Name: Last Name: Address City Province Postal Code Phone Cell Email Languages Spoken English French Other, please specify: Current Occupation: Specific or particular skills, if any (i.e., musician, artist, culinary, etc.): Do you have any prior volunteer experience? Yes No If yes, please specify: Has someone close to you died in the last 12 months? Yes No Do you have any experience working or volunteering in a hospital setting or with people who are ill? Yes No How did you hear about our volunteer program and why do you want to volunteer at the Teresa Dellar Palliative Care Residence? VOLUNTEER POSITIONS (please check all that interest you) Please visit our website for additional details about these positions Auxiliary Volunteer (i.e., event support, administrative support, musician, etc.) Bereavement Support Caller Community Ambassador Gardening Volunteer Housekeeping Volunteer Kitchen Volunteer Laundry Volunteer Meal Service Volunteer Nav-Care Navigator Volunteer Patient Care Volunteer Reception Volunteer Welcome Ambassador/Relief Reception Young Ambassador Volunteer Other, please specify: 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
