Volunteer Form

    Your Name: (required)

    Address:

    Postal code:

    Telephone
    Home:
    Cell:
    Work:

    Your Email: (required)

    Best time to call: ampmevening

    Date of birth:
    (While this is optional, it will help us greatly in compiling our statistics)

    Age range: 18-2425-3435-4950-6465-7475+

    Languages
    Spoken: EnglishFrench   Other:
    Written: EnglishFrench   Other:

    Education: High-schoolUniversityPost-graduate

    Experience and skills
    Describe your work experience

    Describe your volunteer experience

    Describe any specific skills or hobbies which would be useful to your work as a volunteer
    (also make note of any computer skills)

    Cancer experience
    Cancer diagnosis
       Date:
       Diagnosis:

    Diagnosis of family member(s)
       Date:
       Diagnosis:
       Date:
       Diagnosis:
       Date:
       Diagnosis:

    Diagnosis of a close friend
       Date:
       Diagnosis:

    No experience

    Other

    Chemo - What type?HormonalRadiotherapy
    What was the experience like? Describe your experience (treatments, outcomes, etc.)

    Have you lost a family member or close friend to cancer? If so, when:
    Please describe your experience of this loss?

    Motivation - Please describe how you heard about Hope & Cope and your reasons for applying to volunteer in the program.

    Coping - What helped you to cope with the difficult issues related to your personal experiences with cancer? And/or with your experiences with loss?

    Please describe the strengths you feel you have for volunteer work in this program.

    As this is an understandably difficult area in which to work, please describe any concerns you have and the help you feel you would need to work effectively.

    Please give the name and phone numbers of THREE references (either personal or professional)
                Name:
               Phone:
    Relationship:
                Name:
               Phone:
    Relationship:
                Name:
               Phone:
    Relationship:
    Permission for police check: YesNo

    Please indicate the day / schedule you hope to follow
    (prioritize your 1st and 2nd choices)

    First choice
    Mondayampmevening
    Tuesdayampmevening
    Wednesdayampmevening
    Thursdayampmevening
    Fridayampmevening
    Saturdayampmevening
    Sundayampmevening

    Second choice
    Mondayampmevening
    Tuesdayampmevening
    Wednesdayampmevening
    Thursdayampmevening
    Fridayampmevening
    Saturdayampmevening
    Sundayampmevening

    Please select the areas in which you are interested in volunteering
    Hospital VisitingPalliative Care Volunteer Program (4Main)Peer Counselling / MentoringOncology / Radiotherapy ClinicsSelf-Help Group FacilitatorPR and/or Education of Volunteers & PublicOffice - TypingOffice - Familiar with computersOffice - Familiar with data base entryDeveloping and Updating Resource Information & Educational ToolsLibraryCoping Skills TrainingComplementary Therapies - Relaxation Training, Art Therapy, Yoga, Qi Gong, Massage, etc.Bereavement ProgramNewsletter publicationWebsite developmentWellness Centre - Exercise, Nutrition, Office Reception, Registration, etc.Fundraising - Friends of Hope & CopeFundraising - Young Adult Division (Denim & Diamonds)Fundraising - Other


    Confidentiality
    I will respect the right of the patients and their families to strict confidentiality concerning; the diagnosis, prognosis, family dynamics and any information of a medical, spiritual or psycho-social nature. This information is shared with me as part of a sacred trust and I will divulge none of it to others.

    Training and on-going learning
    I will attend the Hope & Cope orientation sessions, the McGill training program for Palliative Care volunteers (if applicable) and attend educational programs arranged for volunteers within the department, as part of my commitment to continuous on-going learning.

    Respecting the schedule
    I will respect the schedule arranged for me during my probationary period in order to shadow my partner, and keep to the schedule which I later establish in collaboration with the Volunteer Coordinator. I will notify theVolunteer Coordinator of any change of schedule, within a reasonable delay, and attempt to find a replacement volunteer for my shift.


    I have read and acknowledge the above terms:

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