PARENT/LEGAL GUARDIAN CONSENT for YOUTH VOLUNTEER

Alberta Health Services requires Parent/Legal Guardian consent for all Youth Volunteers under
the age of 18 to participate as volunteers and to consent to the disclosure of their personal
information, including health information, as set out in the requirements below.

Youth Volunteers with Alberta Health Services are required to:

• Commit to a negotiated length of active service
• Attend a Volunteer General Orientation which includes policies, expectations and
general information (Some assignments will also require additional training)
• Provide two references
• Sign a Confidentiality and User Agreement which outlines a volunteer’s responsibility
to keep information private, and the expectations for using AHS systems (e.g. not
sharing system login
information, downloading and installing applications or programs)
• Obtain a Police Information Check or Criminal Record Check. Alberta Health Services
is required by legislation (Protection for Persons in Care Act) to ensure that the staff
and volunteers who are caring for our patients are thoroughly screened
• Sign a Consent to Collect, Use and Disclose Photograph, Video and/or Sound
Recordings to allow the use of their image or recordings taken during their service for
education, recognition, presentations or promotional purposes.
• As required by the Communicable Disease Assessment Policy (Policy 1170) complete
the Communicable Disease Assessment Form and provide the related immunization
records – measles, mumps, rubella, chicken pox, whooping cough, hepatitis B,
tetanus, polio, tuberculosis, and may include meningococcal and typhoid
• As required by the Immunization of Workers for COVID-19 Policy (Policy 1189) submit
proof of being fully immunized against COVID-19

Youth Volunteers with Alberta Health Services are strongly encouraged to:
• Obtain an annual influenza vaccination

Youth
First Name Last Name

Parent/Legal Guardian
I am the Parent/Legal guardian for the youth named above. The youth has my permission to participate as a
Youth Volunteer with Alberta Health Services, and I consent to the disclosure of the required personal
information above.
First Name Last Name

Signature Date (yyyy-Mon-dd)

The personal information collected for this program is collected under the authority of section 33(c) of the Freedom of
Information and Protection of Privacy Act (Alberta). It will only be used or disclosed as necessary for the administration and
management of volunteers in the Volunteer Services program. If you have questions or concerns about the collection, use or
disclosure of personal information for this program, please email volunteer_resources@ahs.ca.