Volunteer With Us

Name

Home Address

City

Postal Code

Phone

Email

Your Age Category Youth (6-18)Adult (19-65)Senior (65+)

Is your interest in volunteering part of your required 40 hours of Community Service for your high school graduation? YesNo

If yes, which high school do you attend?

Some of the Simcoe Hall Settlement House volunteer opportunities require a Police Records Check. Do you currently have a valid Police Records Check? YesNo

If no, are you willing to have one done? YesNoI have one

Have you completed CPR First Aid or other similar training? YesNo

Do you have any health restrictions, conditions or medications that we should be aware of to ensure your comfort or safety? If so, please provide details:

Emergency Contact Name

Telephone:

Please explain why you would like to volunteer at Simcoe Hall Settlement House:

Please provide the days, times and frequency that you are available:

Please list any special skills, interests, hobbies or knowledge that you bring to Simcoe Hall Settlement House:

What is/are your areas of interest? Food Bank ServicesSeniors Lunch & Leisure ProgramsChristmas Food & Toy DriveChildren’s After School ProgramSpecial Event & Fund RaisingRepairs

Please provide the name and telephone number of at least two references:

If a volunteer opportunity is not available for you at this time, can we contact you at a later date? YesNo

Staff, student placements and volunteers of Simcoe Hall Settlement House may receive, view or hearconfidential information. The protection of our clients / members right toprivacy and confidentiality is critical and must be maintained by all Simcoe Hall Settlement House employees, directors, volunteers and students placements.“Confidential Information” means information, in any form, that if disclosed to a third Party outside of Simcoe Hall, or discussed in a public venue, may cause harm to a client, member or to Simcoe Hall Settlement House itself. Confidential information also includes any personal identifying information such as a name, address,and telephone number, date of birth or personal circumstances.If an employee, director, volunteer or student placement has any doubt as to whether or not certain information is confidential, he/she must seek and obtain direction from a supervisor or director. Confidential information can not be disclosed without the written and informed consent of the person it pertains to. A breech of confidentiality can result in suspension or dismissal.
I agreeI do NOT agree

“I AGREE TO INDEMNIFY AND HOLD HARMLESS Simcoe Hall Settlement House, its agents, employees or volunteers of all liability for loss or damage arising from any cause whatsoever and hereby release, waive and discharge Simcoe Hall Settlement House from all liability to my heirs, executors, administrators and assigns for all loss or damage and any claims or demands for such loss or damage on account of injury to person or property while participating in and/or being transported to and from the program activities of Simcoe Hall Settlement House.
I agreeI do NOT agree

I Herby give permission to Simcoe Hall Settlement House to provide or arrange for such first aid or other medical treatment or care including but not limited to transportation to hospital, as such staff may consider necessary or advisable. I understand that all costs related to such actions shall be my responsibility and I agree to pay for and/or reimburse Simcoe Hall Settlement House for any such costs as any may incurred.”“I accept full responsibility for ensuring that I am physically and medically fit to participate in the programs and activities of Simcoe Hall Settlement House throughout the duration of my field placement or volunteer servicem.
I agreeI do NOT agree