Volunteer Application

The personal information you are about to enter in this online form shall remain confidential and will not be shared with any other person or organization. The information is intended solely for record keeping and reporting purposes.

"*" indicates required fields

Step 1 of 2

50%

Name*

First Last

Gender*

Male

Female

Prefer not to say

Other

Address*

Street Address Address Line 2 City ProvinceAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code

Phone Number*

Email*

Date of Birth*

DD slash MM slash YYYY

Age*

Are you a Canadian citizen?*

Yes

No

Are you a landed immigrant?*

Yes

No

If you are a landed immigrant, in what year did you come to Canada?*

Please enter a number from 1900 to 2099.

Are you currently employed?*

Yes

No

What languages do you speak (other than English)?*

Educational background*

Elementary

Secondary

Bachelors

Masters

Some university

Doctorate

Post-doctoral studies

Other

Which program are you interested in volunteering with?

Volunteer Youth Program Homework Help/EAL Support Facilitator

Family mentor Canada Connects

Volunteer Conversation Circle Facilitator

Other

Will anyone else be volunteering with you?*

Yes

No

If yes, please indicate: (If it is an adult, he/she will be requested to fill out a Host Volunteer Application)*

Have you volunteered previously?*

Yes

No

If Yes, Organization, type of work, date?*

Please indicate your availability

Morning

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Afternoon

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Evening

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

References

Please provide us with three references that are not family members

Reference #1 - Name*

First Last

Reference #1 - Contact Number*

Reference #1 - Email*

Reference #2 - Name*

First Last

Reference #2 - Contact Number*

Reference #2 - Email*

Reference #3 - Name*

First Last

Reference #3 - Contact Number*

Reference #3 - Email*

Parent Consent Form

Parents Of Youth Under The Age Of 18 Must Read And Sign The Consent Below!

Parent/Guardian's Name*

First Last

Parent/Guardian's Contact Number*

Any pre-existing medical issues or allergies that may affect your child's participation?*

Yes

No

Please Specify*

I/We know that sufficient information has been provided by the Youth Worker with respect to the planned activity, duration, location, participants and supervision.*

Yes

No

I/We understand that the rules and regulations established for the program are designed for the safety and protection of the participants and hereby undertake to inform and expect my child to abide by these rules and regulations.*

Yes

No

I/We hereby give permission for photos and or videos of my child captured during the activity to be used by Regina Open Door Society in promotional materials through website, social media, newsletters, posters and publications waiving my rights of compensation or ownership thereto.*

Yes

No

I/We hereby allow my child to be captured and or interviewed by the press in the event of a media coverage.*

Yes

No

I/We consent to my child's in the program and I am aware of the risks of injury. These types of injuries may be minor or serious and may result from one's actions, or the inaction of others, or a combination of both. I consent to my child's participation in spite of such risks.*

Yes

No

I/We acknowledge that it is my responsibility to advise Regina Open Door Society of any medical or other conditions that may affect my child's participation in the program.*

Yes

No

In the event that my child requires medical attention, I consent to my child being transported to the nearest emergency facility including by ambulance if necessary, and accept that I am responsible for any costs of such service.*

Yes

No

Parent/Guardian's consent/signed*

Yes

No

Date Signed*

DD slash MM slash YYYY