I want to volunteer...

Do you have an interest in working with older adults? Do you have time and energy you would like to share? Do you want to make a difference in someone’s life? We’d like to hear from you!
Seniors Connect is in the business of connecting people. Take a senior shopping or to an appointment, shovel their walkway, share a cup of coffee once a week. We will match you to a senior in the community and let the connecting begin.

Whether you are looking for volunteer hours for high school, want to lend a helping hand or have a desire to give back to the community, contact us!

“To the world you may be one person but to one person you may be the world.” Taylor Hanson



Name:

Street Address:

City:

Postal Code:

Contact Number:

Email Address:


What days of the week would you be available?
Monday Tuesday Wednesday
Thursday Friday Saturday Sunday

What months of the year are you available?
January February March April
May June July August
September October November December

How much time are you able to spend volunteering?
Weekly Bi-weekly Monthly
Other considerations regarding availability:




Transportation Services Friendly Visiting

When is the best time to reach you?
Morning Afternoon Evening



Are you affected by any special health restrictions which limit the kind of volunteer work that you may perform?
No Yes (please describe below)




Name:

Contact Number:

Email Address:

Relationship to Volunteer:




Please list three people who have knowledge of your qualifications. References should have known you for a minimum of two years. Must not be immediate family.


Name:

Relationship:

Phone Number:

Length of time known:



Name:

Relationship:

Phone Number:

Length of time known:



Name:

Relationship:

Phone Number:

Length of time known:


How did you hear about volunteer opportunities for Seniors Connect?
Newspaper Radio Internet Word of Mouth Other

I give my permission for the references above to be contacted in connection with my application for a volunteer position with Seniors Connect.

I understand that the screening process of Seniors Connect of Grey-Bruce includes an application form, an interview and reference checks. Upon receipt of a conditional offer of a position I understand that some positions may also require additional checks such as driving licenses, insurance confirmation and police checks.

I agree to the above statements.