Community Living Durham North

Volunteer Application Form
Please fill out the following online application form. You will receive a confirmation receipt by email.

CONTACT INFORMATION

Name:
Address:
City:
Postal Code:
Email:
Home Phone Number:
Business Phone Number:
Age Category:	14-16 17-19 20-30 31-54 over 55

We like to acknowledge our volunteers on their birthdays, during what month of the year may we send you a card?

VOLUNTEER EXPERIENCE

Organization:
Dates:
Duties:

Organization:
Dates:
Duties:
HOBBIES & INTERESTS (check all that apply)

arts and crafts sewing group leadership organizing events child care	dancing, singing writing/literacy public relations swimming driving	clerical sports public speaking woodworking bowling
Other

TRANSPORTATION

Driver's License? Yes No	Class of License:
Are you willing to use your car during your activities as a volunteer? Yes No

ADDITIONAL INFORMATION

How did you hear about our Association's Volunteer Program?

Why are you interested in becoming a volunteer with Community Living?

With whom would you prefer to volunteer? (check all that apply)
Adult Male Adult Female Program Special Events

When would you be available to volunteer? (check all that apply)
Day Evening Weekday Weekend Year Round Summer Only

How often are you available to volunteer?
Once a week Every other week Once a month
Other

REFERENCES

Name:
Mailing Address:
Email:
Telephone:
Relationship:

Name:
Mailing Address:
Email:
Telephone:
Relationship:

AGREEMENT

I hereby declare that the foregoing information is true and complete to my knowledge. I, hereby authorize the Volunteer Coordinator/Program Director to contact the references listed on this application.

I Agree I Disagree

Thank you for your interest in Community Living Durham North.

"Community Living Durham North gratefully acknowledges the financial support of The Ontario Trillium Foundation, an agency of the Ministry of Culture. The Foundation receives annually $100 million of government funding generated through Ontario's charity casino initiative."