Volunteer Application Form Name * Address * City * Province * Postal Code * Primary Phone Number * Secondary Phone Email Address * I confirm I am 18 years of age or older. * I confirm I am 18 years of age or older. How did you hear about Bethell Hospice? Please indicate briefly why you are interested in becoming a hospice volunteer. Do you speak any languages other than English? Please specify. Please select areas of interest within Residential Program (Inglewood) Gardening Grief & Bereavement Support Kitchen Maintenance Reception Resident Support Holistic Therapy Practitioner Please select areas of interest within Community Program (throughout Caledon & Brampton) Grief and Bereavement Support In-Home Visiting Holistic Therapy Practitioner Please select areas of interest regarding organization-wide support: Administrative Support Community Outreach Event Support Other Areas of Interest/Special Skills: What interests, hobbies and/or skills do you have that you can share with Bethell Hospice and its clients? What times are you available during the week? Monday Morning Afternoon Evening Tuesday Morning Afternoon Evening Wednesday Morning Afternoon Evening Thursday Morning Afternoon Evening Friday Morning Afternoon Evening Saturday Morning Afternoon Evening Sunday Morning Afternoon Evening Are you available for weekends on occasion? Yes No How many hours per week would you be available to volunteer? Other availability comments: Please provide the name and daytime phone numbers of 2 references (non-family members please): Are you willing to have a vulnerable sector police check? Yes No Please forward a copy of this completed form to the following email address for my records: * Messages sent via the internet can be intercepted. If you are concerned about providing your personal information by email or website form submission, please contact us directly at 905-838-3534 to arrange for an alternate method of communication. For more information, please refer to our Bethell Hospice Privacy Statement. Submit If you are human, leave this field blank.
