Volunteer Application - SEHC Foundation Site

First Name

Last Name

Address

Apt #

City/Town

Province

Postal Code

Telephone:

Phone Home

Phone Cell

Email:

Email Home

Email Other

Volunteer Location

I am interested in these volunteer roles (check all that apply and note location)

Journey Home Hospice Companion Volunteer (Toronto & Windsor) - social interaction, accompany patients on outings, play games, etc.

Journey Home Hospice Reception Volunteer (Toronto only) - answer phones and doors, receive deliveries, accompany visitors, assist with administrative tasks, etc.

Journey Home Hospice Kitchen Volunteer (Toronto only) - prepare meals, snacks, and desserts according to dietary requirements, grocery shopping, meal planning, etc.

Friendly Phone Calls (Windsor only) - social interactions, listen and provide emotional support, etc.

Elizz Paws - friendly visiting with your approved canine companion (currently on hold)

Student Placement Opportunity

Briefly, state why you would like to volunteer with Saint Elizabeth Foundation?

Have you previously taken Hospice Training?

Yes

If yes, when, where?

Do you speak a language other than English?

Yes

If yes, please state language or languages spoken

Working with the dying and bereaved may trigger our own loss history. Have you had a person close to you die within the last year?

Yes

Saint Elizabeth Foundation provides service to individuals and their families without consideration of race, ethnic background, sexual orientation, or religion.

Are you willing to follow this policy?

Yes

How did you hear about our volunteer program?

This is an application to volunteer with the Saint Elizabeth Foundation Programs for which there is no monetary compensation.

I understand that the information provided in this application:

Is part of the permanent volunteer file at Saint Elizabeth Foundation.
Is kept confidential in secure storage and only available to authorized staff and volunteers
Will be used to assist Saint Elizabeth in completing its volunteer screening process
May be used for educational or evaluative means without providing any indicators

I also understand that if I am accepted as a volunteer with Saint Elizabeth Foundation I am agreeing to:

Fulfill the training requirements respective to the volunteer role
Attend related volunteer support & education sessions provided by Saint Elizabeth
Abide by the policies and procedures of Saint Elizabeth Foundation Programs

Signature

Date

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