Volunteer Registration Form

Volunteer Information

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone *

Email *

Proposed Role or Type of Engagement: *

Occupation and Employer:

How Long:

Volunteer Experience: *

How Long:

Employment Experience:

Interests, Hobbies:

Special Skills, Language:

Formal Certifications (e.g., WHIMIS, First Aid, SafeTALK)

Type of Volunteer Work Preferred

Available to Volunteer Work *

How did you hear about our organization?

Names and telephone number of other references

organization? or Role

Professional / Employment

Family and / or Friends

I acknowledge that submission of this application does not guarantee approval and that the West Nipissing Community Health Centre may decline or discontinue engagement if misalignment or concerns arise.
I understand that a Vulnerable Sector Check and Reference Checks are conditions of volunteering for programs that service vulnerable populations at the West Nipissing Community Health Centre.

Accessibility