"Support Worker/Volunteer Application Form" - Town of Bracebridge, Ontario, Canada

This "Support Worker/Volunteer Application Form" is a document issued by the Bracebridge Recreation Department specifically for Ontario residents with its latest version released on July 1, 2015.

Download the up-to-date fillable PDF by clicking the link below or find it on the forms website of the Bracebridge Recreation Department.

ADVERTISEMENT
ADVERTISEMENT

Download "Support Worker/Volunteer Application Form" - Town of Bracebridge, Ontario, Canada

Download PDF

Fill PDF online

Rate (4.7 / 5) 63 votes
BRACEBRIDGE RECREATION DEPARTMENT
SUPPORT WORKER/VOLUNTEER APPLICATION FORM
Inquiries: Phone: 705-645-3037
Fax: 705-645-3030
Website: www.bracebridge.ca
Support/Volunteer Worker’s Name (Print): ____________________________________________
Organization (if applicable): _______________________________________________________
Address: _____________________________________ Apt# _____City:___________________
Province: ___________________________ Postal Code:_______________________________
Telephone: _______________________Email:________________________________________
Skills or training the Support Worker has to support the member / participant named below:
_____________________________________________________________________________
Paid ____
Volunteer _____
Name of Member / Participant being supported: ________________________________________
What type of support does this individual require? (i.e. assistance with mobility; dressing; emotional
support; supervision etc.) __________________________________________________________
What is the support person’s role? ___________________________________________________
Activities / Programs Planning to Attend: ______________________________________________
Dates & Times: __________________________________________________________________
In case of emergency contact: Name: _______________________________________________
Telephone:
(Home) _____________ (Cell) _____________ (Business) ___________________
Relationship to Member/ Participant: _________________________________________________
Signature of Support Worker:_______________________________________________________
Date: _________________________________________________________________________
For office use only:
Manager Signature: ____________________________________________________________
Date: ________________________________________________________________________
Any Required Communication:
_____________________________________________________________________________
P: Forms & Templates\Recreation\Registration, Membership & Volunteer Forms\Volunteer & Support Worker Application Form
revised July 2015
BRACEBRIDGE RECREATION DEPARTMENT
SUPPORT WORKER/VOLUNTEER APPLICATION FORM
Inquiries: Phone: 705-645-3037
Fax: 705-645-3030
Website: www.bracebridge.ca
Support/Volunteer Worker’s Name (Print): ____________________________________________
Organization (if applicable): _______________________________________________________
Address: _____________________________________ Apt# _____City:___________________
Province: ___________________________ Postal Code:_______________________________
Telephone: _______________________Email:________________________________________
Skills or training the Support Worker has to support the member / participant named below:
_____________________________________________________________________________
Paid ____
Volunteer _____
Name of Member / Participant being supported: ________________________________________
What type of support does this individual require? (i.e. assistance with mobility; dressing; emotional
support; supervision etc.) __________________________________________________________
What is the support person’s role? ___________________________________________________
Activities / Programs Planning to Attend: ______________________________________________
Dates & Times: __________________________________________________________________
In case of emergency contact: Name: _______________________________________________
Telephone:
(Home) _____________ (Cell) _____________ (Business) ___________________
Relationship to Member/ Participant: _________________________________________________
Signature of Support Worker:_______________________________________________________
Date: _________________________________________________________________________
For office use only:
Manager Signature: ____________________________________________________________
Date: ________________________________________________________________________
Any Required Communication:
_____________________________________________________________________________
P: Forms & Templates\Recreation\Registration, Membership & Volunteer Forms\Volunteer & Support Worker Application Form
revised July 2015