Volunteer Application Form

Please complete this application form if you are interested in learning more about volunteering with the Chatham-Kent Hospice. Once you complete the form, click the Continue button at the bottom.

General Volunteer Application

You can also submit this form by mail. Download the volunteer form by clicking here, and mail to Chatham-Kent Hospice, 34 Wellington St. East, Chatham, ON N7M 3N7. Thank you for your interest in the Chatham-Kent Hospice. Please fill in all the field to the best of your ability.

Chatham-Kent Hospice is committed to protecting your privacy. We promise to keep all the information that you share with us confidential. We only collect personal information for our use as outlined above and will not share, sell or distribute your information with any outside parties.

Demographic Information

First name:

Last name:

Title/Preferred Gender Pronouns:

Street:

Street 2:

City:

Province:

* Postal code: *

Home phone:

OK to call me here

Work phone:

OK to call me here

Cell phone:

OK to call me here

Email address:

Alternate Email:

Date of birth:

(year optional)

Language ( additional):

Emergency Contact

Please indicate who we can contact in case of emergency while you are volunteering with us

First name:

Last name:

Home phone:

Alternate phone:

Relationship:

Availability

Please indicate the days and times you are usually available to volunteer.

Skills and Interests

Describe the skills or interests you would be able to share (arts and crafts, music, computers/social media, administrative, cooking/baking, good listener, leadership, caring, compassionate, professional)

Volunteering matching

is there anything else you would like us to consider when matching you with an appropriate volunteer role?

* Assignment Preference:

1st choice:

2nd choice:

3rd choice:

Volunteer Personal References

These individuals must be over 20 years of age, should have known you for more than 2 years and may NOT be a partner, spouse or family member. References will be conducted online, please provide an email address. By sharing your references on this application, you are providing consent and give your permission to the Volunteer Coordinator to contact the above references in regards to your application after the completion of the interview.

1

2

First name:

Last name:

Home phone:

Work phone:

Cell phone:

Email address:

Relationship:

Volunteer Agreement

I understand that not all applications will be accepted, and that I agree to provide a recent criminal reference check as part of the required screening process at time of interview.

I Agree