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2nd Annual Believe…Women’s Gala
2nd Annual Charity Motorcycle Ride
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905-728-7525
info@simcoehall.com
Home
About Us
About Simcoe Hall
Our Board
Programs
All Programs
Holiday Toy Registration Form
After School Program
Ski Program
Holiday Food & Toy Drive
Day Camps
Events
4th Annual Golf Tournament
Annual Charity Car Wash
Annual Great Pumpkin Auction
2nd Annual Believe…Women’s Gala
2nd Annual Charity Motorcycle Ride
Supporters / Sponsorships
Contact Us
– Donate –
Volunteer With Us
Volunteer With Us
Name
Home Address
City
Postal Code
Phone
Email
Your Age Category
Youth (14-18)
Adult (19-65)
Senior (65+)
Is your interest in volunteering part of your required 40 hours of Community Service for your high school graduation?
Yes
No
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?
Yes
No
If no, are you willing to have one done?
Yes
No
I have one
Have you completed CPR First Aid or other similar training?
Yes
No
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 Information
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 Services
Seniors Lunch & Leisure Programs
Christmas Food & Toy Drive
Children’s After School Program
Special Event & Fund Raising
Repairs
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?
Yes
No
Volunteer and Student Confidentiality Policy
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 agree
I do NOT agree
STUDENT PLACEMENT AND VOLUNTEER CONSENT AND HOLD HARM AGREEMENT
“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 agree
I do NOT agree
CONSENT TO MEDICAL TREATMENT
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 agree
I do NOT agree