Support Worker/volunteer Application Form printable pdf download

BRACEBRIDGE RECREATION DEPARTMENT

SUPPORT WORKER/VOLUNTEER APPLICATION FORM

Inquiries: Phone: 705-645-3037

Fax: 705-645-3030

Website:

Support/Volunteer Worker’s Name (Print): ____________________________________________

Organization (if applicable): _______________________________________________________

Address: _____________________________________ Apt# _____City:___________________

Province: ___________________________ Postal Code:_______________________________

Telephone: _______________________Email:________________________________________

Skills or training the Support Worker has to support the member / participant named below:

_____________________________________________________________________________

Paid ____

Volunteer _____

Name of Member / Participant being supported: ________________________________________

What type of support does this individual require? (i.e. assistance with mobility; dressing; emotional

support; supervision etc.) __________________________________________________________

What is the support person’s role? ___________________________________________________

Activities / Programs Planning to Attend: ______________________________________________

Dates & Times: __________________________________________________________________

In case of emergency contact: Name: _______________________________________________

Telephone:

(Home) _____________ (Cell) _____________ (Business) ___________________

Relationship to Member/ Participant: _________________________________________________

Signature of Support Worker:_______________________________________________________

Date: _________________________________________________________________________

For office use only:

Manager Signature: ____________________________________________________________

Date: ________________________________________________________________________

Any Required Communication:

_____________________________________________________________________________

P: Forms & Templates\Recreation\Registration, Membership & Volunteer Forms\Volunteer & Support Worker Application Form

revised July 2015

Support Worker/volunteer Application Form