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NHSN VOLUNTEER REGISTRATION 

VOLUNTEER REGISTRATION FORM 

Submission Deadline: Sunday, December 12, 2021.  Questions? Email admin@hhca-london.ca

FIRST NAME LAST NAME ADDRESS LINE 1 ADDRESS LINE 2 CITY, PROVINCE AND POSTAL CODE EMAIL ADDRESS CONTACT NUMBER
This number is my
Landline
Mobile
HOW DO YOU PREFER TO BE CONTACTED?
Email
Text
Phone
No Preference
HAVE YOU VOLUNTEERED WITH HHCA BEFORE?
Yes
No
WHEN ARE YOU AVAILABLE TO VOLUNTEER?
Mornings (10:00a-1:00pm)
Afternoons (12:00pm to 3:00pm)
Afternoons (2:00pm to 5:00pm)
Evenings (5:00 to 8:00pm)
WHAT DAYS OF THE WEEK ARE YOU AVAILABLE TO VOLUNTEER?
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
ARE YOU VOLUNTEERING FOR SECONDARY SCHOOL VOLUNTEER HOURS?
Yes
No
WHAT IS YOUR SCHOOL NAME?
IF YOU ARE VOLUNTEERING TO DELIVER THE GOODY BAGS, DO YOU POSSESS A VALID DRIVER'S LICENSE?
Yes
No
Not Applicable
DO YOU HAVE VALID AUTO INSURANCE?
Yes
No
No Applicable
DO YOU REQUIRE ACCOMMODATIONS TO VOLUNTEER EFFECTIVELY AND SAFELY?
Yes
No
If YES, how can we make this a comfortable, positive volunteer experience?
I UNDERSTAND AND AGREE TO THE FOLLOWING EXPECTATIONS: 1. I will work collaboratively and cooperatively with other volunteers, exercising mutual respect, patience, tolerance and understanding. 2. I will keep the Organizing Team informed if my plans change and I am unable to complete my assignment or shift. 3. I will not accept compensation from recipients. 4. I will respect and follow the Covid19 protocols in place. 5. If I am delivering the Festive Goody Bags to homes, I will wear visible identification (name tag with photo ID will be provided) and identify myself as a volunteer of Huron Heights Community Association. 6. I will not post photos of recipients to social media, even with their permission.
Yes, I have read and understand the expectations.
I am voluntarily participating in the Neighbours Helping Senior Neighbours Community Initiative [NHSN] and I am participating in the activities entirely at my own risk. I am aware of the risks associated with participating in this activity such as personal physical injury and damage. I assume all related risks, both known and unknown to me, of my participation in this community initiative.
Yes, I agree.
SIGNATURE (Write in Your Name) DATE (Write in the date) Submit