Be a Volunteer – PCC Ottawa

PERSONAL CONTACT INFORMATION

Name*

First Last

Your Landline Number*

Your Mobile Number*

Preferred Way To be Contacted*

Phone
Email

Best time to contact you by phone*

Morning
Afternoon
Evening
Anytime

Your Email*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

ONLINE ORIENTATION AND TRAINING FOR VOLUNTEERS

As part of the orientation process, and under the guidance of the Canadian Red Cross, all volunteers need to undergo basic training in COVID-19 protection and community outreach protocols.

To prepare for the best day/time of this orientation, please indicate your top 3 preferences for this online orientation activity in the box below

Saturday, Morning (between 9 AM to 12 PM)
Saturday, Afternoon (between 1 PM to 5 PM)
Saturday, Evening (between 6 PM to 9 PM)
Sunday, Morning (between 9 AM to 12 PM)
Sunday, Afternoon (between 1 PM to 5 PM)
Sunday, Evening (between 6 PM to 9 PM)
Weekdays, Morning (between 9 AM to 12 PM)
Weekdays, Afternoon (between 1 PM to 5 PM)
Weekdays, Evening (between 6 PM to 9 PM)

Please specify your other time availability for online orientation activity*

VOLUNTEER SKILLS, SERVICE AND AVAILABILITY 

Have you worked with seniors before? if yes, please tell us about your experience. (Note: your experience could be paid work, volunteer work, or a personal eperience where you have engaged with seniors for an extended period of time),

VOLUNTEER EMERGENCY CONTACT

Name*

First Last

Relationship

Contact Number

Email Address

VOLUNTEER DECLARATION 

I DECLARE, that: I have no convictions of offences under the Criminal Code of Canada up to and including the date of this declaration for which a pardon has not been issued or granted under the Criminal Records Act (Canada).

I UNDERSTAND that in case a conviction or offence under the Criminal Code of Canada may be issued to me, I will inform the PCC project team lead immediately.

I GRANT PCC the permission to use any photographs or videotape images of me taken in the course of my involvement in this project, and to use my name, image, comment(s) and information regarding my volunteer role, activities, for the organization’s purposes in any media and territory in perpetuity, and that I will not receive remuneration for such use.

I UNDERSTAND that a Covid-19 health declaration will be part of the assessment prior to any community engagement.

I WAIVE and release any and all claims for myself, my heirs, executors and administrators against PCC and any other sponsor or organization involved, from any and all claims or liability for sickness, death, personal injury or property damage of any kind however caused, including any claim or liability arising from the negligence of PCC, its agents, servants, or employees and of any person on site, arising out of, or in the course of, my participation as a volunteer for which I choose to participate.
This Release and Waiver extends to all claims, foreseen or unforeseen, known or unknown.

During the CONTINUANCE of my volunteer placement or any time after the termination thereof, I agree to keep confidential and not without the express written consent of PCC disclose to any person or organization any donor, volunteer, financial, business or other proprietary or private information of PCC which I may have acquired during the course of my volunteer placement.

I agree

Signature*

Date*

Parent/Guardian Signature (if volunteer is under 18 years old)

Date

Privacy Statement and Consent*

I agree and understand that PCC may collect, use and disclose personal information about me for the stated purpose mentioned above.
I do not wish my personal information to be collected, used and disclosed.

By providing us with your personal information, you consent to our data collection, use and disclosure. The personal information you shared in this form, will be used by PCC for the following purposes: For promotion of programs and services, for reporting to donors and funding organization, and for any PCC promotional and awareness campaigns.

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