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VOLUNTEER APPLICATION FORM

Name*
Prefix First Last
Date of Birth*
MM slash DD slash YYYY
Gender*
- Male
- Female
- Other
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Primary Phone Number*
Secondary Number (optional)
Email Address
EMERGENCY CONTACT INFORMATION
Emergency Contact Name*
First Last
Relationship to Volunteer*
Emergency Contact Telephone Number*
INFORMATION ABOUT YOU
How did you learn about volunteering at Hospice Vaughan?*
Why do you want to be a volunteer with Hospice Vaughan?*
Give a brief description.
Do you speak and/or write any languages other than English?*
- Yes
- No
If yes, please specify which language(s) spoken.*
Do you have any previous or present volunteer positions? If yes, please list them here.*
In which capacity would you like to volunteer?*
(Please check all that apply)
- Reception
- Family and Residential Care (Hospice Residence)
- In-Home Visiting Program
- Adult Grief and Bereavement Support Groups
- “Caring Hands” Day Program
- Complementary Therapy (Yoga, Reiki, Meditation and Mindfulness, Other)
- Kitchen and Nutrition (Hospice Residence)
- Environmental Services (Gardening and Maintenance Work)
- Outreach, Special Events and Fundraising
Are you or have you been a client of Hospice Vaughan (or another Hospice)?*
- Yes
- No
If yes, when and in what capacity?
Have you had any experience with death, dying, palliative care, or terminal illness?
- Yes
- No
If yes, please explain briefly.
Do you have any accessibility requirements that should be considered in relation to how you can help others?*
REFERENCES - Please provide two references whom we may contact
Please list a professional reference. This can be a manager, supervisor, coworker, teacher, counselor etc.
Name*
First Last
Relationship*
Phone*
Please list a personal reference. This can be a friend, neighbour, volunteer, etc. (Note: this should not be a family member).
Name*
First Last
Relationship*
Phone*
I AGREE THAT THIS FORM IS ACCURATE AND TRUE*
- Yes
- No

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HOSPICE VAUGHAN
9383 Islington Avenue
Vaughan, Ontario
L4H 3G7

info@hospicevaughan.com
Phone: 1-905-850-6266
Community Services Referral Fax: 1-905-850-7987
Residence Referral Fax:
1-289-256-2084

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