Chai Lifeline Canada: Volunteer

Would you like to get involved with our association? Please check all that apply

Title:
First Name:*		Last Name:*
Age:*
Occupation:		Years Employed:
Address:*
City:*		Province:*
Postal Code :*
Home Phone:*		Bus. Phone:
Cell:		E-mail:*
Special Skills (teaching(include subjects), arts&crafts, musical instruments, etc.)
Other than English, list languages spoken fluently
References
Name		Phone
Relationship
Name		Phone
Relationship
Car Availability:	yes no	How far are you willing to drive?
Which of the services below would you be willing to volunteer? (choose all that apply)
	Big Brother/Big Sister Program		Event Planning/ Dinner assistance
	Respite daytime/ overnight/ Shabbos		Visiting homebound children
	Toy Drive		Transportation/ Deliveries
	I have truthfully completed this application for volunteer service. I understand and am willing to honor the time commitment required for my volunteer assignment and accept direction from Chai Lifeline staff designated. I agree to fully review policies and procedures outlined in the chai lifeline volunteer manual when issued to me.<br /> AGREEMENT OF CONFIDENTIALITY As a chai lifeline volunteer, I understand that in the course of my contacts with families served by Chai Lifeline, I might learn privileged and confidential information that is of a highly personal nature. Examples of such information might be, but are not limited to: medical condition and treatment, finances, living arrangements, employment, identifying information and relationship among family members. I understand that all such information must be treated as confidential.I agree not to disclose any information i learn about patients and their family members to anyone, except a Chai Lifeline staff member. I will also make certain that any disclosures are made in a private setting in which no one can overhear any information that is conveyed. I understand unauthorized disclosures are considered grounds for immediate termination of volunteer status.
	I have read and agree to the Confidentiality Agreement above. *

*required