Sign Up Form

Youth Can Cowichan

Thank you for registering as a participant in the Youth Can Cowichan Volunteer Program at Volunteer Cowichan. For more information on this program please email Holly at youth@volunteercowichan.bc.ca. Once you sign up you will be contacted for next steps and onboarded into the program!
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
YesNo
What is your age?*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you have access to transportation to attend events and activities?*
What are your preferred pronouns?*
YesNo
Do you require any accommodations to participate in the program?*
Name: Emergency Contact / Parental Guardian*
Phone Number: Emergency Contact / Parental Guardian*
Please enter a valid phone number.Format: (000) 000-0000.
Email: Emergency Contact / Parental Guardian*
example@example.com
Thank you to our funders including BC Gaming, TELUS Friendly Future Foundation, and Chances Cowichan.
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Youth Can Cowichan