Volunteer Application Form

Contact Information
Name*
Address*
Street Address Unit / Apt. City Postal Code
Phone*
Cell
Business
Email*
E-mail opt in
- I authorize correspondence for fundraising and promotional purposes
Best Time/Method to contact you*
Emergency Contact Information*
Name Relationship Phone
Contact Details: Contact Details: Contact Details:
Volunteer Opportunities
Select the opportunities you are interested in
- Bingo
- Hair/Nail Makeovers
- Swimming
- Friendly Visiting
- Tutoring
- Day Programs
- Horticulture
- Committees
- Clerical
- Fundraising/Events
- Transportation (Special Events)
- Lottery Calendar Services
Please select your days / times of availability (weekdays)
- Monday Morning
- Monday Afternoon
- Monday Evening
- Tuesday Morning
- Tuesday Afternoon
- Tuesday Evening
- Wednesday Morning
- Wednesday Afternoon
- Wednesday Evening
- Thursday Morning
- Thursday Afternoon
- Thursday Evening
- Friday Morning
- Friday Afternoon
- Friday Evening
Please select your days / times of availability (weekends)
- Saturday Morning
- Saturday Afternoon
- Saturday Evening
- Sunday Morning
- Sunday Afternoon
- Sunday Evening
About You
Special Skills/Talents*
Other Volunteer Experience*
Motivation for Volunteer Service*
- Accumulation of Volunteer Hours
- Possible Employment Leads
- Extra Spare Time
- Possible Career
References*
Name Phone Relationship to You
Reference Details: Reference Details: Reference Details:
Signature*
I authorize Community Living Chatham-Kent to contact the references noted above in order to provide additional information which will assist in the matching process between volunteer/volunteer positions.
Date

Name	Relationship	Phone
Contact Details:	Contact Details:	Contact Details:

Name	Phone	Relationship to You
Reference Details:	Reference Details:	Reference Details:

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