VOLUNTEER INFORMATION FORM

A. Contact Information Date: ____/____/____

(mm / dd / yyyy)

Name: __ __ __ ____ __ __ ____ __ __ ____ __ __ ____ __ __ ____ __ __ ____ __ __ ____ __ _

Address: __ __ __ ____ __ __ ____ __ __ ____ __ __ ____ __ City: __ __ __ ____ __ __ ___ __

Province: __ __ __ ____ __ __ __ Postal Code: __ __ __ ____ __ Date of Birth: ____/____/____

(mm / dd / yyyy)
Home Phone: __ __ __ ____ __ __ __ __ Alternate Phone: __ __ __ ____ __ __

Email Address: __ __ __ ____ __ __ ____ __ __ ____ __ __ ____ __ __ __

School (if applicable): __ __ __ ____ __ __ ____ __ __ Area of Study: __ __ __ ____ __ ____ __

Occupation (if applicable): __ __ __ ____ __ __ ____ __ __ Employer: __ __ __ ____ __ __ ____

Emergency Contact Name: __ __ __ ____ __ __ __ __ __ Relationship: __ __ __ ____ __ __ __

Home Phone: __ __ __ ____ __ __ ____ __ __ __ Alternate Phone: __ __ __ ____ __ __ ____

B. Availability
Please indicate the days and times you are available to volunteer by checking the corresponding boxes.

Monday Tuesday Wednesda Thursday Friday Saturday Sunday

y
Mornings
Afternoons
Evenings

C. Volunteer Opportunities
Please check the programs that interest you.

___ Family Special Events

___ Office Help:

___ Family Centre ___ Promotion Team:

___ Monthly Newsletter ___ On Call Volunteer:

___ Safety Committee ___ Other: (Please specify)

_________________________
D. Signature

All personal information collected is used for services of the Burnside Gorge Community
Association. BGCA does not disclose any personal information to other agencies, funders, or
solicitors.

By signing below, I acknowledge that the information provided to BGCA is true and accurate.

Signature: ___________________________________________ Date: __________________

Thank you for becoming a Burnside Gorge Volunteer!

For more info please contact Kim Perkins at (250) 388-5251 or email: community-bgca@shaw.ca