Volunteer Application Form

HAMILTON & DISTRICT EXTEND-A-FAMILY

VOLUNTEER APPLICATION FORM
Applicant's Name*

First NameLast Name
E-mail Address*
Birth Date*

MonthDayYear
Home Phone Number*

Area CodePhone Number
Cell Phone Number*

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Employer (if applicable)*
School (if applicable)*
I'm interested in the following volunteer opportunities:
Buddy ProgramHost Family ProgramASD/REC Friendship GroupSpecial EventsBoard MembershipOffice AssistanceOther (Please explain below)
Please describe your current living arrangements, providing the first and last name of everyone who resides with you, and their age. Let us know if you have any pets, too! Thanks!
Please describe any relevant volunteer or employment experience you have had. Let us know if you have any experience working with people with special needs.
Tell us a little bit more about yourself!
Please provide the name, phone number, and e-mail address of three people who have worked with you in a work-place, school, or volunteer environment.
Reference's Name*
Phone Number*
E-Mail Address*
Reference's Name*
Phone Number*
E-Mail Address*
Reference's Name*
Phone Number*
E-Mail Address*
Enter as shown.*
Submitted*

MonthDayYearHourMinutesAM/PM Option
Thank you for your interest in Hamilton & District Extend-A-Family!

A coordinator will be in touch with you shortly.

If you have any questions in the meantime, feel free to contact us:

Hamilton & District Extend-a-Family

293 Wellington St. N., Suite 127 Hamilton, ON L8L 8E7

(905) 383-2885 (off.)

eaf@execulink.com

www.extendafamily.synthasite.com
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