Volunteer Form | Italian Canadian Handicapable Association

Personal Information

Name *

Email *

Address *

City *

Province *

Postal Code *

Home Phone

Cell Phone

Date of Birth (MM/DD/YYYY) *

Gender *

Male

Female

Self Identify

Volunteer Information

Type of Volunteer *

Coaching

Bingo

Board of Directors

General Assistance (i.e. fundraising, social events)

Coaching Areas of Interest

Bocce

Soccer

Floor Hockey

Basketball

Other

Additional Certifications

CPR

Defibrillator

First Aid

Clearance & Consent

Vulnerable Sector / Police Clearance *

Yes

No

I consent to have my photo taken for ICHA promotional materials *

Yes

No

References

Reference 1

Name of Reference

Phone Number

Date Contacted

Comments

Reference 2

Name of Reference

Phone Number

Date Contacted

Comments

Reference 3

Name of Reference

Phone Number

Date Contacted

Comments

Additional Information

Additional Information (is there anything else you want us to know?)

How did you hear about the ICHA?

Family/Friends

Media/Advertising

School

ICHA Member

ICHA Website

Volunteer Centre

Signatures

Applicant's Signature *

Date *

Guardian's Signature

Date

ICHA Volunteer Application Form

Personal Information

Volunteer Information

Clearance & Consent

References

Reference 1

Reference 2

Reference 3

Additional Information

Signatures