The Marguerite Centre - Volunteer Form

Volunteer Application Form

Please Print Clearly

Personal Information
Full Name:
Street Address:
City:
Province:		Postal Code:
Home Phone:		Work Phone:
E-mail:

In Case of Emergency Please Contact:

Full Name:

Street Address:

Home Phone: Work Phone:

In Case of Emergency Please Contact:
Full Name:
Street Address:
Home Phone:		Work Phone:

If you have any known medical conditions, allergies (including food allergies) or sensitivities, please outline below:

If you regularly carry any medications, please complete the following:

Drug	Use	Where I Keep It
Drug	Use	Where I Keep It

Please describe the types of volunteer activities including Committee work you would be interested in participating in at The Marguerite Centre:

Please describe any experience you have which qualifies you to perform these activities:

Please list any other organizations you have you volunteered with:

Organization:_______________________________
Duties:

When would you be able to volunteer for The Marguerite Centre? (Days of the week, hours of the day):

Statement of Understanding

I understand that the Executive Director of The Marguerite Centre may request and/or carry out any or all of the following and by signing this document do hereby grant permission to carry out these duties:

Request and follow-up on three references
Request a driver's abstract (if driving residents)
Request a Criminal Records Check
Carry out a Child Abuse Registry check

Signature	Date
Signature	Date

Please print this form, fill in all the fields that apply to you, and submit it to the mailing address on our Contact Us page.

Thank you for your interest in The Marguerite Centre.