Bethell Hospice Volunteer Application Form

Name *

Address *

City *

Province *

Postal Code *

Primary Phone Number *

Secondary Phone

Email Address *

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)

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.

Volunteer Application Form

Thanks to our Funders