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* 1. Applicant Info:

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* 2. Emergency Contact

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* 3. Volunteer Opportunities (Check all that apply)

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* 4. Reference 1

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* 5. Reference 2

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* 6. Reference 3

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* 7. Confidentiality Agreement:

As a volunteer of Seniors Outreach & Resource Centre (operated by Seniors Outreach Services Society), I pledge to observe strict confidentiality concerning information regarding seniors or others accessing the services of Seniors Outreach Services Society.  This includes all personal information, personal issues or concerns regarding a client(s) or her/his family member(s).  I am aware of the limitations to confidentiality, such as when a person is at risk of imminent harm, and will report any concerns I have in this regard to the Manager of Volunteer Programs as soon as possible.  I understand this agreement continues even when I am no longer a volunteer of Seniors Outreach Services Society.
 
Protection of Privacy and Statement of Commitment

·         Respect confidential information and the rights and dignity of all persons with whom I have contact in my volunteer role(s).

·         Advise the Manager of Volunteer Programs immediately, and in advance when possible, of any changes to my volunteering, for example:

o   My availability (i.e. when not able to attend to volunteer activity as regularly scheduled);

o   Client requested change or ending of service.

 
Your personal information provided to Seniors Outreach Services Society will not be used, shared, or distributed in any way, other than for the express purpose for which it was collected.  It is to be used solely for purposes directly related to the recruiting, training and matching of volunteers with vulnerable seniors, to ensure the protection of these senior clients.  It will also be used to provide you with information relating to the volunteer work in which you participate.

 I verify that the information provided in this application is accurate and true. I also understand that volunteering with Seniors Outreach Services Society is dependent on acceptable results from criminal record checks and reference checks. While every attempt is made to secure the volunteer position that is desired, Seniors Outreach Services Society maintains the authority to decide the placement of volunteers. I voluntarily authorize the above noted reference and record checks, and release all persons requesting or providing such information from all liability or responsibility.

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* 8. CHECKLIST & AGREEMENT FOR VOLUNTEERS PROVIDING SERVICES
Emergency COVID-19 Response Services
“Safe Seniors, Resilient Communities”

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