ESC Volunteer Application Form

EDMONTON SENIORS CENTRE

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Volunteer Application Form

THANK YOU FOR THINKING OF US!
Personal Information NOTE: All information on this form is confidential and is for office use only.
Fields marked with * are REQUIRED information and must be provided before submitting the form.

* Indicates required field

Name *

First

Last

Birth Date (dd/mm/yy) *

Street Address *

City *

Postal Code *

Telephone # (please include Area Code) *

Cell Phone # (include Area Code) *

Email Address *

Transportation *

Will you require parking? *

Yes No

Do You Have Any Special Needs We Should Be Aware Of? *

Yes No

If YES, please specify... *

SHIFT AVAILABILITY (please check all that apply):
Our office hours are Monday to Friday from 9 a.m. to 4 p.m.

Monday *

AM PM

Tuesday *

AM PM

Wednesday *

AM PM

Thursday *

AM PM

Friday *

AM PM

PREFERENCES:

Time of Day *

Mornings Afternoons

Frequency *

Regular Shifts Occasional Shifts Summer or School Term (define in Comments)

Comments / Skills / Interests/ Length of Time Available *

Emergency Contact (in Edmonton):

Name *

Telephone # *

Relationship *

VOLUNTEER OPPORTUNITIES (please check any & all areas of interest):

[object Object] *

Back Office Assistant Thrift Shop (10-3) Nevada Desk Crafter (in Home) Crafter (at Centre) Computer Skills Helper

Choose Any *

Special Events/ Set Up/ Clean Up/ Tickets Entertainment/ Musical/ Comedy Services / Clinics (if yes, provide details below) Instructor (if yes, provide details below) General around the Centre :)

Choose Any *

Lead Groups/ Readers/ Cooking/Walk Hot Lunch (Set-Up/Serve/Clean) Bingo Caller / Cashier Casino (every 2 years) Other (please provide details below) Outreach is Long Term & Req. Refs & Police Check

Provide details for services/clinics, instructor or other here: *

Submit

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