NOTE PRIORITY ACTION STEPS: If wanting to move forward to volunteer, please email Mike Nelson at michael@philipazizcentre to indicate this. Be sure you've also attended an online Information Session via Zoom - you can register for this by clicking: INFO SESSION

Please complete as may parts of this form as possible. This form will remain on file in our office. All volunteer information and files are confidential and are available only to authorized staff or volunteers who have signed a confidentiality agreement.

Throughout this form you will see reference to PAC (Philip Aziz Centre) and EH (Emily's House) used interchangeably.

NOTE: Formatting works best on a computer; it is not necessarily optimized to work on smaller devices (i.e. phone).

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* Salutation

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* First and Last Name

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* Address

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* City, Province

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* Postal Code

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* Email Address

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* Cell Phone

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* Alternate Phone Number

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* May we contact you at work?

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* Closest major intersection to your home (e.g. Yonge and Bloor):

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* Are you 18 years old and older? If between 7-17 years old, please stop, and fill out an application at: www.philipazizcentre.ca/yac/

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* What is your age?

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* Gender:

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* What is your birthday (example: August 14)

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* Primary Emergency Contact:

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* Relationship to Emergency Contact

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