Please complete all parts of this form. 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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* Closest major intersection to your home (e.g. Yonge and Bloor):

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* Are you at least 18 years old?

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* Date of Birth (dd/mm/year - example 01/01/2020) - If between 7-17 years old, please stop, and fill out an application at: https://www.philipazizcentre.ca/yac/

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* May we contact you at work?

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* Primary Emergency Contact:

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* Relationship to Emergency Contact

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