Please complete this application form if you are interested in becoming a volunteer at Brockville General Hospital. Once you complete the form, click the Continue button at the bottom of the page to submit your application. 

Questions marked with an * must be completed before submitting the application. Thank you. 

Name and address

Demographic Information

You may optionally provide the following information. It is used only to help us get a better idea of the demographic make-up of our volunteers.

Locator Information

Where did hear about the Volunteer Association and volunteering at the hospital?

Email Preferences

We like to keep volunteers informed of important news, schedules, and volunteer opportunities by email, however will not send you any email you prefer not to receive. Use the checkboxes below to select the kinds of email you would like to receive from us.

Why would you like to be a hospital volunteer?

Area of Interest for Volunteering

Where would you be interested in volunteering in the hospital? Tick the boxes below that apply to you.

Skills & Experience

Tick the boxes below to let us know what experience and skills you have. 


If you speak another language, would you be willing to assist a patient in that other language? If yes, please indicate which language(s):

Emergency Contacts


I hereby apply to become a volunteer with the Brockville General Volunteer Association and have provided to the best of my knowledge true and complete information on this application form. I understand that information provided to the Volunteer Coordinator in these references will be kept confidential. I understand that if suitable volunteer work is available, I will be asked to attend a volunteer orientation session with the Volunteer Coordinator, provide proof of up-to-date immunizations and a Criminal Reference Check and sign a Pledge of Confidentiality before beginning any volunteer assignment.