Heal Canada Volunteer Application Form

Step 1 of 6

16%

Personal Information

Full Name:(Required)

First Last

Date of Birth:(Required)

MM slash DD slash YYYY

Gender:(Required)

Address(Required)

Street Address City Province Postal Code

Phone Number:(Required)

Email Address:(Required)

Availability

Days Available (please check all that apply):(Required)

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Times Available (please check all that apply):(Required)

Mornings

Afternoons

Evenings

How many hours per week are you available to volunteer?(Required)

Skills and Interests

Please describe any relevant skills or experience you have (e.g., healthcare, patient advocacy, administration, event planning, etc.):(Required)

Why are you interested in volunteering with Heal Canada?(Required)

What areas are you interested in volunteering in (please check all that apply):(Required)

Patient Support

Administrative Assistance

Fundraising

Event Planning

Marketing and Communications

Research and Data Entry

Other (please specify):

Other areas are you interested in volunteering(Required)

Background Information

Have you ever volunteered with Heal Canada before?(Required)

Yes

If yes, please describe your previous volunteer experience:(Required)

Do you have any medical conditions or limitations that we should be aware of?(Required)

Yes

If yes, please explain:(Required)

Are you comfortable with providing a reference for your volunteer application?(Required)

Yes

Emergency Contact Information

Full Name:(Required)

First Last

Relationship:(Required)

Phone Number:(Required)

Consent and Signature

By signing below, you certify that the information provided in this application is true and complete to the best of your knowledge. You understand that if accepted as a volunteer, any false statements or omissions may lead to your termination from the volunteer program.

Signature(Required)

Date(Required)

MM slash DD slash YYYY

CAPTCHA