Headwaters Health Care Centre

I understand that volunteers are required to provide proof of vaccination for COVID-19, undergo a current Police Vulnerable Sector Verification Search or Criminal record check (role dependent), a two-phase TB skin test and provide confirmation of immunity to common communicable diseases.
I understand that all confirmed volunteers are required to attend a hospital orientation session, role specific training or shadowing with the Volunteer Convener (or designate) for the role.
I understand that volunteers will be provided with an identification badge with parking access and a volunteer vest prior to the start of their training and initial shift.

First Name:
Last Name:
Preferred Name:
Address:
City or Town:
Postal Code:
Email:
Phone (Best number to reach you on during the day):
Languages spoken:	EnglishFrenchOther
Date of Birth:
Emergency Contact Name:
Emergency Contact Phone Number:
Why are you interested in becoming a Headwaters Volunteer?:
How did you hear about Headwaters volunteer opportunities?:
Previous Volunteer Experience:
What areas of service are you interested in volunteering in? Select all that apply.:	Ambulatory Care Board or Committee Member Day Surgery Diagnostic Imaging Dialysis Emergency Department Inventory/Data management (Excel proficiency) Patient Companion Patient Escort/Inquiry Pulse Cafe/Gift Shop Seconds Count Thrift Shop Wayfinding Other
Are you currently a student?:
Are you currently employed?:
If yes, what is your occupation?:
If no, what was your past employment and skillset?:
When are you available to volunteer? Select all that apply.:	Mornings Afternoons Evenings Weekends
I understand that new volunteers are requested to volunteer for a minimum of 6 months.:
Please confirm that you understand and agree with the following:	I understand that volunteers are required to provide proof of vaccination for COVID-19, undergo a current Police Vulnerable Sector Verification Search or Criminal record check (role dependent), a two-phase TB skin test and provide confirmation of immunity to common communicable diseases. I understand that all confirmed volunteers are required to attend a hospital orientation session, role specific training or shadowing with the Volunteer Convener (or designate) for the role. I understand that volunteers will be provided with an identification badge with parking access and a volunteer vest prior to the start of their training and initial shift.
Please provide the names of two (2) references who can supply information regarding your skills/performance (excluding relatives).: