Volunteer Application Form

Please complete this application form if you are interested in becoming a Wentworth Lodge- City of Hamilton volunteer. Once you complete the form, click the submit button at the bottom.

Applicant's Contact Information

First name:

Last name:

Street 1:

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:

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.

Date of birth:

(year optional)

Age range:

Gender:

Education:

School:

Emergency Contact

First name:

Last name:

Home phone:

OK to call here

Work phone:

OK to call here

Cell phone:

OK to call here

Relationship:

References

1

2

First name:

Last name:

Street 1:

Street 2:

City:

Province:

Postal code:

Home phone:

OK to call here

Home phone:

OK to call here

Work phone:

OK to call here

Work phone:

OK to call here

Cell phone:

OK to call here

Cell phone:

OK to call here

Email address:

Relationship:

Contacted:

Verified:

3

First name:

Last name:

Street 1:

Street 2:

City:

Province:

Postal code:

Home phone:

OK to call here

Work phone:

OK to call here

Cell phone:

OK to call here

Email address:

Relationship:

Contacted:

Verified:

Assignment Preferences

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

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.

What kinds of email would you like to receive?

Electronic newsletters

Recruitment appeals

I Agree

I understand that submitting this application form does NOT yet register me as a Wentworth Lodge volunteer. The following are required qualifications:

*interview with the Co-ordinator of Volunteers

*Recent 'Clear' Vulnerable Sector Police Check

*Proof of completed recent 2 Step TB test

*Confidentiality Agreement

*Acknowledgement and understanding of Volunteer Handbook

I Agree