Vol.Reg.Form 2016

VOLUNTEER INFORMATION APPLICATION FORM

  1. General Volunteer Information:

Last Name: ______Given Name: ______Initial:_____

Address: ______Apt. #: ______

City: ______Province: ______Postal Code: ______

Residence :( ) ______Cell: ( ) ______Business: ( ) ______

Email: ______

Date of Birth:Day: _____ Month: ______

Age Group: ___ 14 -17___ 18-64___ 65 and over

Care Card Number: ______

In case of emergency contact:

Name: ______Residence :( ) ______

Cell: ( ) ______Business: ( ) ______

Current Occupation: ______

Company Name: ______

Contact: ______Phone: (604) ______

-OR- if you are a Student:

Name of School/city ______

Completed and Ongoing Education: ______

______

Hobbies, Skills, and Interests:

______

Written & Spoken Languages: ______

______

Please tell us how your education, interests and skills will benefit LMDSS: ______

Please provide two References and their Contact Information:

1).Name: ______

Address: ______Apt. # ______

City: ______Province: ______

Postal Code: ______Telephone: ( ) ______

Email: ______

2). Name: ______

Address: ______Apt. # ______

City: ______Province: ______

Postal Code: ______Telephone: ( ) ______

Email: ______

(Please refer to LMDSS Volunteer Opportunities Sheet to complete the following :)

Please mark the days and times available that you can volunteer.

__ Monday__ AM __ PM

__ Tuesday__ AM __ PM

__Wednesday __ AM __ PM

__ Thursday__ AM __ PM

__ Friday __ AM __ PM

__Saturday __ AM __ PM

__Sunday__ AM __ PM

Are you available for special assignments? __ Yes__ No

Are you available to come into the office to work on a project? __ Yes__ No

  1. Other Details and Information:
  1. Vulnerable Sector Criminal Record Check:

AVulnerable Sector Criminal Record Check must be completed and returned to the LMDSS office.

A Vulnerable Sector Criminal Record Check will need to be updated every 5 years.

Vulnerable Sector Criminal Record Check that were issued fromanother society or organizationcannot be used. All Vulnerable Sector Criminal Record Check forms must have the name of the Lower Mainland Down Syndrome Society on them.

Vulnerable Sector Criminal Record Check information can be found at

You must go into your local police department or R.C.M.P. detachment (whichever is applicable in your area) to obtain a Vulnerable Sector Criminal Record Check form. Please make sure to take along the CRC LMDSS cover letter so no fees apply.

Two to Three pieces of picture ID will be required.

  1. Is there any additional information you would like us to know? ______
  1. How did you learn about the Lower Mainland Down Syndrome Society?

___ TV/Radio___ Volunteer Website

___ Word of Mouth___ LMDSS Website

___ Other

  1. LMDSS Volunteer Commitment and Pledge:
  1. I agree to adhere to the Lower Mainland Down Syndrome Society requirements to make a minimum 6–month commitment to my volunteer position.
  2. I will be punctual and will notify the Lower Mainland Down Syndrome Society of any necessary absences from duty as far in advance as possible.
  3. I will carry out my duties to the best of my abilities.
  4. I will be notified if my assignment contains confidential information, and if so, I will not discuss it with anyone outside of my volunteer assignment.
  5. I will not use the Lower Mainland Down Syndrome Society equipment for personal use, includingcomputers and any programs, photocopiers and postage meter.
  6. I will record my volunteer hours on an approved timesheet and submit the timesheet to the General Manager at the end of each month.

I agree to the above commitment and pledge:

______Date: ______

(Signature of Volunteer)

______Date: ______

(Witness)

  1. Authorization for the use of photos and name(s):

I authorize photographs of myself or family including a minor under my custody or an adult for whom I am authorized to make decisions to be used by LMDSS for the purpose of pamphlets, newspaper ads, LMDSS newsletter, or web content. I understand that giving my consent to this will mean no financial payments will be made to me by LMDSS.

______Date: ______

(Signature of Volunteer)

______Date: ______

(Witness)

Thank you for completing this application form, and we welcome your interest in volunteering with the Lower Mainland Down Syndrome Society! We will confirm that your application has been received and advise you of any vacancies.

VOLUNTEER OPPORTUNITIES

The following lists services and programs where volunteers are needed. Please indicate where your interests lie and for further information on volunteer opportunities, please look atthe LMDSS website: .

Youth and Adults:
__ Youth Group (ages 11 to 18)
__ Adult Group (ages 19 & up)
__ Kid’s Group (ages 6 to 10)
__ Kid’s Sport Coordinator
__ Kid’s Sport Committee (6 to 12)
__ Youth Sport Coordinator
__ Youth Sport Committee (13 & up)
__ Fine Arts Program Committee
__ Summer Camp (ages 17 to 30)
__ After-School Group / Networking & Fundraising:
__ Fundraising Coordinator
__ Grants Coordinator
__ Social Coordinator
__ Social Committee
__ Event Coordinator
__ Event Committee
__ Special Events Coordinator
__ Special Events Committee
Office Resources:
__ Office Assistant
__ Library Assistant
__ Parent Support Group Coordinator
__ Parent Support Committee
__ Special Projects Coordinator
__ Special Projects Committee
__ Educational Programs Coordinator
__ Educational Programs Committee
__Outreach Parent Team (Training provided
through LMDSS) / Other Resources:
__ Volunteer Coordinator
__ Conference Committee
__ Board of Directors
__ Treasurer
__ Newsletter Editor
__ Newsletter Assistant
__ Consulting Services (must have training,
certificates)
__ Speech, Behavior, OT, PT Therapy (must have
certificates)