Community Living Durham North

Home pixel About pixel Services pixel Get Involved pixel Links pixel Contact Us pixel
pixel
pixel
pixel

Get Involved

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.

United Way pixel
Trillium Foundation
"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."
pixel
Home About Us Services Get Involved Links Contact Us
Copyright ©2005 Community Living Durham North, All Rights Reserved.