Required fields are marked with asterisks (*)

55+ Active Adults Volunteer Application

Name

Phone Number

Cell Phone Number

Address

City

Postal Code

Email Address

Emergency Contact

Name

Relationship

Phone Number

Alternate Phone Number

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What volunteer area are you interested in?

Receptionist/Greeter

Drop-in program assistant

Special events assistant

Coffee lounge/Kitchen assistant

Older Adult Committee Member

Other

Tell us about your skills and experience (e.g. training, certifications, hobbies, etc.).

Do you have any accessibility requirements? e.g. can't stand for long periods, etc.

Check each day you can commit to volunteering.

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

For each day you selected, tell us if you are available in the morning or afternoon.

Why are you interested in volunteering with 55+ Active Adults?

Please list your volunteer experience.

Conditions, Waiver and Release of Liability

Check each box to indicate you agree with the following statements.

I agree to provide a Criminal Background Check that includes a vulnerable sector search issued within the last six months.

I understand that the Municipality of Clarington has a Zero Tolerance policy in terms of deviation from any and all their rules, especially concerning Health and Safety.

I understand that failure to comply with any of the above requirements means I am no longer eligible to perform volunteer work for the Municipality of Clarington.

I certify that the information I have given is true and that any misrepresentation of facts may result in my losing the privilege of volunteering. I understand that the Municipality of Clarington has the right to deny my request to volunteer. I authorize the investigation of all statements in this application.

I release the Municipality of Clarington from any causes of action, obligations, litigations and claims that may arise out of my performance of volunteer work/services for the Municipality of Clarington.

Personal information provided is collected under authority of the Municipal Act, 2001, S.O. c.25, and will be used to determine eligibility for volunteering for the 55+ Active Adults purposes only. Questions about this collection should be directed to the Municipal Clerk, 40 Temperance Street, Bowmanville, ON L1C 3A6, 905-623-3379.

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55+ Active Adults Volunteer Application

Emergency Contact

Conditions, Waiver and Release of Liability