Please complete and submit this form to be considered as a volunteer at the Region of Waterloo Museums.

Name and Address

First name:

Last name:

Alternate Name:

Street:

City:

Province:

* Postal Code: *

Home phone:

Cell phone:

Email address:

Demographic Information

Please indicate your age range. The minimum age to volunteer is 15. Youth volunteers under the age 18, must provide a year of birth. This information will be used for volunteer recognition and establishing eligibility to volunteer for certain roles.

Date of birth:

* (year optional)

Age Range:

Availability

Indicate the days and times you are available. Please note our hours of operation have been impacted by COVID-19 restrictions and will vary as provincial and municipal regulations change.

Sun

Mon

Tue

Wed

Thu

Fri

Sat

From:

To:

My availability is:

From:

to:

Maximum number of hours:

Frequency:

Languages

Please indicate languages (other than English) that you are able to speak and/or write at a level that would allow you to understand and be understood.

Personal Goals

Please describe what you hope to achieve personally by volunteering at the museum. Please indicate if you require volunteer hours to be reported to a third party (e.g. school, employer, government program).

Why the museum?

Please describe why you are interested in volunteering at the museum.

Where would you like to volunteer?

Please indicate the museum site(s) where you would like to volunteer. Check as many as apply.

* Museum Site Preference:

Doon Heritage Village

Ken Seiling Waterloo Region Museum

McDougall Cottage Historic Site

Schneider Haus National Historic Stie

Which volunteer activities interest you?

Please indicate volunteer activities that interest you. Please check as many as apply.

Specific Volunteer Role

Please name any specific volunteer roles you are applying for. A list of current volunteer openings can be found on our websites.

Relevant skills, experience or certifications

Please indicate any other skills, experience or certifications you have that would be beneficial in your role as a museum volunteer.

References

Please provide 2 non-family references.

1

2

First name:

Last name:

Home phone:

Cell phone:

Email address:

Relationship:

Emergency Contact

First name:

Last name:

Home phone:

Work phone:

Cell phone:

Email address:

Relationship:

Collection of Personal Information

By checking on the agree checkbox below I agree and consent to:

• Submitting my name for consideration as a volunteer with the Region of Waterloo Museums

• Authorizing the Region of Waterloo to contact the references I have provided to furnish an relevant information they may have concerning my suitability as a volunteer with the Region of Waterloo

• Providing my personal information for the defined purpose and described legislative authority stated below.

Notice of Collection: Personal information on this form is being collected by the Regional Municipality of Waterloo and will be used to qualify you to volunteer at the Region of Waterloo Museums. This information is collected, used and disclosed in accordance with section 28(2) of the Municipal Freedom of Information and Protection of Privacy Act and under the authority of section 2 of the Municipal Act. Questions about this collection can be directed to Debbie Moxam, Coordinator of Volunteer Services at dmoxam@regionofwaterloo.ca.

I Agree