ACT Volunteer Registration

ACT Volunteer Form
Disclaimer

On March 30, 2020, the Chief Medical Officer of Health released a statement "strongly reccomending" that individuals over 70 years of age self-isolate. In general it is also strongly recommended that vulnerable and/or immunocompromised people self-isolate to protect themselves. If you are over the age of 70, vulnerable or immunocompromised, we would ask that you enter this information into the comments section at the end of this form and an attempt will be made to find an appropriate alternative voluntary task for you.
Volunteer Information
Name *

First Name Last Name
Are you between the age of 18-60? *
Email *
Phone Number *

Area Code Phone Number
What type of volunteer are you? *

Community Volunteer Staff
Screening Questions
Have you had new or worsened cough or difficulty breathing? *
Do you have a fever? *
Have you experienced any cold (such as running nose) and/or influenza symptoms? *
Have you experienced diarrhea, vomiting, and other gastro symptoms? *
Have you experienced any other symptoms of illness? *
Yes / No / Other (please specify)
Have you travelled outside of Canada in the past 14 days? *
Have you had close contact with a confirmed or probable case of COVID-19? *
Have you had close contact with a person with acute respiratory illness who has travelled and returned in the past 14 days? *
Availability
Please indicate all days you are available: *

Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Number of hours available (per day):
First date available: *

Month Day Year
Date
Areas of Service:
Here are some of the possible areas to volunteer. Please check any that you have experience in and/or willing to help out with: *

Serving to-go meals (Saturdays, Sundays, Mondays) Picking up and delivering groceries to residences Delivering food hampers
Do you have a valid driver's license? *

Yes No
If Yes, do you have access to a vehicle? *

Yes No
Please rate your comfort level with front line work on a scale of 1 to 5. *
(1 being not at all and 5 being very comforatable)
Any questions or comments about your registration: (Please feel free to contact info@cdspc.org)
Thank you for your interest and we will be in touch shortly with more information.
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ACT Volunteer Form

Disclaimer

Thank you for your interest and we will be in touch shortly with more information.