Last Name (required)
FirstName (required)
Street Address (required)
City (required)
Province (required)
Postal Code (required)
Phone Number (required)
Your Email (required)
Emergency Contact (required)
Emergency Contact Phone Number (required)
Hospital PorteringWater ProgramSewing and RepairsGift Shop Sales ClerkPalliative CareEntertainment/Music
Grove Nursing Home Recreation ProgramSpecial Events/OutingsMeal AssistanceMinisterial/Bible StudyVisiting/Palliative CareEntertainment/Music
Hospital Auxiliary - Opportunity Shop Sales ClerkSorters
Community Programs Adult Day Program1:1 ActivitiesMeal AssistanceHousekeeping
Hospital Off-Site/At Home Sewing and RepairsCrafts
Education History (required)
Work History (required)
Special Skills/Certificates/Interests (required)
Volunteer Experience(required)
I understand that per the ARH Auxiliary by-laws I must volunteer a minimum of 24 hours between April 1 through March 31 every year, or I will be removed from the Arnprior Regional Health volunteer list.
The information I have provided on this application form is complete and accurate to the best of my knowledge. Any misrepresentation or deliberate omission of a fact will be justification for refusal of the opportunity to volunteer and just cause for the termination from the Arnprior Regional Health volunteer program.
I acknowledge that I have read, understood and agree to the above statements. (required)
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