Brampton Civic Hospital: Pandemic Volunteer Application

Thank you for your interest. Unfortunately, at this time we are not accepting any high school applications until further notice. If you are available weekdays, during day time we need your support. Please apply below:

Pandemic Volunteer Requirements

The current age requirement to volunteer at William Osler Health System is 15 years of age or older. Do you meet the age requirement?

Yes:

No:

Type

Please select one option: Adult, University/College or High School

Type:

Contact Information

First name:

Last name:

Street 1:

Street 2:

City:

Province:

* Postal code:

Home phone:

Cell phone:

Email address:

Emergency Contact

In the event of an emergency whom should we notify?

First name:

Last name:

Title:

Street:

City:

Province:

Postal code:

Home phone:

Work phone:

Relationship:

Pandemic Volunteer Opportunity

Please share why you are interested in volunteering at Osler as a pandemic volunteer.

Immunizations

Priority will be given to those who have proof of completed immunizations. For reasons of patient safety, hospitals should have documented proof of immunity to Measles, Mumps, Rubella and Varicella and a two-step Mantoux test is also required (TB).

Please select which proof of immunization you currently have:

Immunization:

Availability

Day/Times Availability: Indicate the days and times you are available. Please note timings vary depending on each role.

I Agree

I understand and agree that submitting this application form does not automatically register me as a William Osler Health System volunteer, and that there may be certain requirements I must meet, including the acceptance of established volunteer policies and procedures before I may begin volunteering.

By submitting this form, I attest that the information I have provided on the form is true and accurate.

I Agree