Volunteer Registration Form
Please fill in the form below.
All volunteers ages 18 years and older require a valid Police Records Check - Vulnerable Sector (issued one-year of volunteer registration date). Forms can be completed through the Jean Augustine Centre
I would like to volunteer as:
Program & Workshop facilitator leading programs
Program and Workshop Support
Office & Administrative Support
Special Events (usually weekends and evenings)
Other or general support (garden maintenance, organizing and clean up, community outreach, etc.)
If 'Program & Workshop facilitator leading programs' was chosen please specify which programs you are interested in:
STEM
Arts & Crafts
Academics
Mindfulness
Physical Activity
Cooking & Nutrition
Empowerment Camps
Other
Please specify days and times available:
I am a:
High School Student Volunteer
College/University Volunteer
Other
I am under the age of 18:
Yes
No
Full Name:
*
Home Address:
*
Primary Phone Number:
*
-
Area Code
Phone Number
Cell Phone Number:
-
Area Code
Phone Number
Email Address:
*
School (If in High School, College or University):
Emergency Contact Name:
*
Emergency Contact Phone Number:
*
-
Area Code
Phone Number
Known Health Concerns (Allergies, Medication, or Special Needs):
Reference 1 Full Name:
First Name
Last Name
Reference 1 Relationship:
Reference 1 Phone Number:
-
Area Code
Phone Number
Reference 1 Email:
example@example.com
Reference 2 Full Name:
First Name
Last Name
Reference 2 Relationship:
Reference 2 Phone Number:
-
Area Code
Phone Number
Reference 2 Email
example@example.com
I currently have a valid Police Records - Vulnerable Sector check that was issued within one-year of registration form date (if over the age of 18 years)?
*
Yes
No
Police Record Check Date of Issue
I am currently certified in First Aid and CPR
*
Yes
No
First Aid and CPR Date of Issue:
Photography Release- I give permission for J.A.C. staff to take photographs of me during programs for potential use in future promotional materials.
*
Yes
No
I have read and understand the information presented in this form. I agree to cooperate with all J.A.C. procedures and regulations. Signature
*
Clear
Would you like to be contacted via text messages about J.A.C.'s programs, workshops, and events?
Yes
No
Submit Form
Print Form
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