AutoID
System Generated
Busy onTask
N
Y
Date of Last Completed Task
-
Month
-
Day
Year
Date
Name
*
First Name
Last Name
Mobile Phone Number
*
Email
*
example@example.com
Volunteering Information
Please indicate which area(s) you are willing to provide your service (check all that apply):
*
All of Toronto _
1 - Etobicoke North _
2 - Etobicoke Centre _
3 - Etobicoke Lakeshore _
4 - Parkdale-High Park _
5 - York South-Weston _
6 - York Centre _
7 - Humber River-Black Creek _
8 - Eglinton Lawrence _
9 - Davenport _
10 - Spadina-Fort York _
11 - University-Rosedale _
12 - Toronto-St.Paul's _
13 - Toronto Centre _
14 - Toronto-Danforth _
15 - Don Valley West _
16 - Don Valley East _
17 - Don Valley North _
18 - Willowdale _
19 - Beaches-East York _
20 - Scarborough Southwest _
21 - Scarborough Centre _
22 - Scarborough-Agincourt _
23 - Scarborough North _
24 - Scarborough-Guildwood _
25 - Scarborough-Rouge Park _
Please indicate below all languages, beyond English, that you are able to speak:
Chinese (Mandarin) _
Chinese (Cantonese) _
Italian _
Punjabi _
Tagalog _
Spanish _
Portuguese _
French _
Hindi _
Urdu _
Farsi, Persian_
Arabic _
Somali _
Do you have a car or access to a car?
*
Yes
No
Have you or someone in your household travelled outside of Canada in the last 14 days ?
*
Yes
No
Please indicate below all languages that you are able to speak:
Please indicate the times you are able to help (between 9 AM and 6 PM):
All day _
Morning (9AM - Noon) _
Afternoon (Noon - 3 PM) _
Evening (3PM - 6PM) _
Privacy Information
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please upload a copy of a government issued photo ID (e.g. driver's license or passport): *Note: This information is being collected as a measure to further ensure the safety of seniors and volunteers. This information will be kept private and confidential on a secured server at the University Health Network.
*
Upload a Photo
Cancel
of
Please share any additional information about yourself that you feel is important for the organizers to know:
Please share links to your public online profiles (e.g. LinkedIn, Twitter, Facebook, personal website):
Emergency Contact
Name
*
First Name
Last Name
Phone Number
*
-
Country Code
-
Area Code
Phone Number
Email
example@example.com
Relationship
*
References (one reference MUST be work, school, or another volunteer organization)
For the safety of seniors, please share two references (one reference MUST be work, school or another volunteer organization).
Reference 1 - Name
*
First Name
Last Name
Phone Number
*
Extension
x 12345
Email
example@example.com
Relationship
*
Reference 2 - Name
*
First Name
Last Name
Phone Number
*
Extension
x 12345
Email
example@example.com
Relationship
*
Back
Next
Volunteer Declaration
Below is a series of Volunteer Declaration statements that you should review carefully. If you agree with the statement, please check each box to give your consent before submitting the form. As a Friendly Neighbour Hotline volunteer, you are expected to take precautions and act within the scope of responsibility as outlined in the Standard Operating Procedure and be faithful in honouring your volunteer commitments. You agree to exercise all reasonable care as to not disclose the private information of seniors nor expose them to unnecessary risk through extended and/or unnecessary exposure.
I certify that the information provided on this Volunteer Information Form is true and complete. I hereby give consent to the staff, representatives, volunteers and/or agents of UHN OpenLab to contact and connect me with a senior living in the Toronto area in need of help with the acquisition of essential items during the COVID-19 outbreak. I understand that: 1) My contact information will be shared with a senior in need; 2) I agree to keep all information related to the seniors I serve confidential, including their name, address, phone number, and details of their request. I understand that the documentation provided will be used solely for the purpose of verifying identities and will not be disclosed unless required by law.
*
I have read and agree with the above statements. I hereby give my consent.
By participating in this program, I, the Volunteer, release and forever discharge and hold harmless UHN OpenLab, Toronto Community Housing and The City of Toronto (the ‘Organizers’), and its successors and assigns from any and all liability, claims, and demands of whatever kind of nature, either in law or in equity, which arise or may hereafter arise from the services I provide to Friendly Neighbour Hotline initiative. I understand and acknowledge that this Release discharges the Organizers from any liability or claim that I may have against Organizers with respect to bodily injury, personal injury, illness, death, or property damage that may result from my participation.
*
I have read and agree with the above statements. I hereby give my consent.
As a volunteer, I commit to handling each and every interaction with care and patience, ensuring above all that the care and wellbeing of seniors are maintained. In submitting this application I acknowledge that I understand all of the above and commit to following them in my capacity as a Friendly Neighbour Hotline volunteer.
*
I have read and agree with the above statements. I hereby give my consent.
Submit
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