Volunteer in Seniors Services

Contact Information

* Name

* Address

* City/Town Select City...Fort ErieGrimsbyLincolnNiagara FallsNiagara-on-the-LakePelhamPort ColborneSt. CatharinesThoroldWainfleetWellandWest Lincoln

Province Ontario Alberta Britsh Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Prince Edward Island Quebec Saskatchewan Yukon

* Postal Code

* Home Phone xxx-xxx-xxxx  Ext.

Cell Phone xxx-xxx-xxxx

Email

  I am a high school student seeking community volunteer hours

Emergency Contact Information

If you are volunteering with us, and an emergency arises, whom should we contact?

* Name

* Home Phone xxx-xxx-xxxx  Ext.

Alternate Phone xxx-xxx-xxxx  Ext.

Availability

Days Available: Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
Saturdays
Sundays

Times Available: Mornings (8 a.m. - noon)
Afternoons (Noon - 4 p.m.)
Evenings (4 - 8 p.m.)

Hours per Week hours

Volunteer Positions

* Select the location you would like to volunteer at:

* Select all volunteer positions you are interested in applying for at this location:

Work Experience

Provide any relevant work experience to the position you are applying for:

Provide any relevant volunteer experience to the position(s) you are applying for:

Provide any relevant hobbies / interests to the position(s) you are applying for:

List all languages spoken fluently:

References

Provide us with two non-family references that we can contact on your behalf.

* Reference 1 Name

* Reference 1 Phone xxx-xxx-xxxx  Ext.

Reference 1 Email

* Reference 2 Name

* Reference 2 Phone xxx-xxx-xxxx  Ext.

Reference 2 Email

  * I give my permission to contact the above individuals

Additional Information

Have you ever been convicted of a criminal offence and not been granted a pardon? Yes No

Why do you want to volunteer with Niagara Region Seniors Services?

Provide any additional information you would like to share with us

Personal Information and Privacy

Any personal information or personal health information submitted in writing will be collected, used and disclosed by members of Regional Council and Regional staff in accordance with the Municipal Freedom of Information and Protection of Privacy Act or the Personal Health Information Protection Act, where applicable.

Freedom of Information

Any information you share will be used only for the intended purpose for which it was provided. If you have any questions, email foi@niagararegion.ca or call 905-980-6000 ext. 3779.