Required fields are marked with asterisks (*)

LTC Volunteer Application Form

Thank you for your interest in becoming a volunteer. Please complete the application below. The information you provide will help us determine the best volunteer opportunities and placement for you.

We are here to help and are committed to ensuring that everyone can participate, contribute, and be heard. If you require assistance or need a different survey format, please contact the Life Enrichment Manager at 705-645-4488 ext. 4824 or christina.rochette@muskoka.on.ca

Personal information on this form is collected under the authority of the Municipal Freedom of Information and Protection of Privacy Act, 1990 and Municipal Act 2001 for the purposes of applying to volunteer at one of the District's long-term care homes. Personal information will be used and disclosed only for these purposes. By providing personal information, you consent to its collection, use, and disclosure. Contact: Clerk for the District Municipality of Muskoka, clerk@muskoka.on.ca or 705-645-2100 ext.4253

Date of application

First Name

Last Name

Address

Postal Code

Phone Number

Cell Phone Number

Email Address

Birth Date (Optional)

What languages do you speak?

Please list any previous volunteer experience

Please tell us how you learned about our volunteer program

Emergency Contact Name

Relationship to Emergency Contact

Emergency Contact Phone Number

Alternate Contact Person and Phone Number

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LTC Volunteer Application Form