Volunteer Application 2022                                                                                          
Community Engagement Coordinators- Sandra Gammage & Kathleen Cameron
sandra@silverheightsneighbourhood.com 
kathleen@silverheightsneighbourhood.com


This form is to be filled out by individuals 13+ who are interested in obtaining a volunteer position at Silverheights Neighbourhood Association, Greenway-Chaplin Community Centre, Preston Heights Community Group.

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Email *
Application Date *
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Please provide your name *
Please provide your address *
Please provide your phone number *
Please indicate your age category *
Which Cambridge neighbourhood association do you wish to volunteer with? *
Role - Is there a specific type of volunteer role that interests you the most? *
Experience- Please list any work or volunteer experience that may be relevant *
Interest - How did you learn about our volunteer opportunities? *
Availability & Hours - Please let us know your availability throughout the week and if there is a total number of hours that you are looking to gain. *
Placement - Are you seeking a student placement? *
If 'Yes', please let us know through what school, and how many hours you are seeking.
If you answered 'Yes' to the previous question, what school are you attending and how many hours are you seeking?
Volunteer Screening- Have you ever been convicted of a criminal offence for which a pardon has been granted? *
Emergency Contact- Please provide your emergency contact as well as the best phone number to reach them at. (Name, relationship to them, phone) *
Medical Information: any know allergies, medical conditions, health concerns, medications or disabilities *
What is your Covid-19 vaccination status? *
Required
1. Authorization and RELEASE: I, in my personal capacity and on behalf of the participant, do hereby RELEASE FROM ALL LIABILITY Silverheights Neighbourhood Association, Preston Heights Community Group, and Greenway-Chaplin Community Centre, its Directors, volunteers, employees, agent and representatives (hereinafter Releasee) for any injuries, illnesses, or other mishap that may be incurred by the participant while attending a registered, drop in or online program or event, except where damage or injury is caused by the gross negligence of the Releasee.  In the event the participant should be injured or become ill, I authorize any medical treatment that may be required and will assume full financial responsibility for the said treatment. At no time is the Releasee liable for the action/inaction of any support worker supplied by and/or for the participant.  2.  Personal Information collected on this form is obtained incompliance with the Personal Health Information Protection Act (PHIPA) and will used only for the purpose of the SNA, PHCG, and GCCC.  Questions about the collection of personal information should be directed to the SNA Health Information Custodian by calling 519-249-1200. 3. I understand that this form shall be completed no less than each calendar year.  4.  I, the Participants Legal Guardian, agree not to share links and meeting I.D. information with outside parties who are not registered with Silverheights Neighbourhood Association, Greenway-Chaplin Community Centre and Preston Heights Community Group and am aware of the risks and dangers associated in sharing information.  I acknowledge and fully understand, appreciate and accept the inherent risks associated with my child’s participation in virtual and online activities provided by Silverheights Neighbourhood Association, Greenway-Chaplin Community Centre and Preston Heights Community Group BY SIGNING THIS RELEASE YOU ARE RELEASING YOUR LEGAL RIGHTS AGAINST SNA, PHCG and GCCC. *
VOLUNTEER AGREEMENT & RELEASE WAIVER FORM: in applying to perform duties for Silverheights Neighbourhood Association, Preston Heights Community Group, and Greenway-Chaplin Community Centre as a volunteer, I fully understand and agree to the following: 1. That I will not be participating in volunteer activities in the capacity of an SNA employee or independent contractor.2. That I will not receive any remuneration, salary, wage, or payment or any employee benefit whatsoever, or be covered by the Workplace Safety and Insurance Act, 1997, S.0. 1997 Chapter 16, Sch. A.3. That I will only use SNA facilities and equipment when authorized 4. That I will immediately notify the appropriate SNA, PHCG, or GCCC supervisor of any incident that involves personal injury or property damage during my volunteer duties. 5. That either SNA, GCCC, or PHCG or I myself may terminate my volunteer activities at any time. 6. I acknowledge that volunteer activity may involve personal risk of damage or injury. Not withstanding this acknowledgment, I hereby release SNA, PHCG, GCCC, Board of Directors, employees, and agents from all claims for damage or injury to myself resulting from my participation as a volunteer, unless such damage or injury is caused solely by the gross negligence of SNA, PHCG, and GCCC. 7. I understand that a volunteer position is conditional upon a 30 day probationary period, during which all statements made on this application may be verified. 8. It is my responsibility to read and understand the permanent volunteer related policies, procedures, and guidelines of SNA, PHCG, and SNA. I also agree to follow these polices, procedures and guidelines as passed by the Board of Directors 9. I understand and agree that privileged information received about program participants, volunteers, and/or staff of SNA, PHCG, GCCC is confidential. It may only be revealed to my direct supervisor within the SNA, PHCG or GCCC. Failure to maintain confidentiality may be cause for my immediate dismissal or will be means for other corrective action. 10. Traveling on offsite trips and activities may be required during my volunteer position. Volunteers will be accompanied by staff and/or senior volunteers. Prior notice/schedules of activities will be provided.    By signing this form I acknowledge having read, understood and agreed to the above conditions, release and waivers, for any volunteer role that I am assigned and agree to perform for SNA, PHCG and SNA. *
Required
Photographic Release Waiver-I hereby give permission to SNA, PHCG and GCCC for use of my picture in any promotional material including advertising, brochures, publications, video productions or any social media uses. I waive the right to any fee or compensation for either the photographic sitting or the use or reproduction of the resulting photographs in any medium. I understand these materials may be used by SNA, PHCG and GCCC. *
Required
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