Required fields are marked with asterisks (*)

Woodingford Lodge Volunteer Application Form

Fill out this form to submit an application to volunteer.

Full Name

Home address & Postal Code

Primary Phone

Work Phone

Email address

Age (if under 18)

Language(s) Spoken

English

French

Other

*Please Note: Volunteers wishing to volunteer more than 150 hours per year will be required to complete a 2 Step TB skin test for which they will be reimbursed.

In case of emergency please notify:

Name and Phone of Emergency Contact

Relationship to emergency contact

Please list any volunteer experience that may be relevant

Please list any particular skills, hobbies, interests or certifications that may be relevant

Please note: Additional training is required, and will be provided through Woodingford Lodge, for volunteers wishing to be on the Palliative Care Team

I can volunteer

regularly once or twice weekly

once in a while if needed

special events only

other (ex. Seasonally)

Preferred Location

Woodstock

Ingersoll

Tillsonburg

Do you prefer to volunteer

mornings

afternoons

evenings

weekdays only

weekends only

other

Reference name and phone number # 1

Reference name and phone number # 2