Volunteer Application

Thank you for your interest in volunteering with our organization. Please be advised, by clicking "submit", you are giving us permission to contact your references and certify that all information is correct and realize that falsified information could lead to your termination with this agency. You also agree to allow Community Support Connections to keep both personal and health information required for you to provide service. You also agree to allow CSC to send you a monthly volunteer e-newsletter, which you can unsubscribe from
at any time.




First name

Last Name



Postal code


Home phone

Birthdate (optional)

Age category

Occupation (optional)

Current place of employment (optiona)

(if retired, previous place of employment/ description of work)

Work phone

Cell phone

Emergency contact

Emergency contact's phone number

Relationship of emergency contact

How did you hear about our organization?

List any languages in which you are fluent

Check all that apply

Friendly visitorMeals on wheels driver/ runnerDriver escortOffice volunteerMeals on wheels order packer/ carrier cleaner/ porter/ labelerTelephone support volunteerList shopperCommunity dining host/ hostessBingo volunteerBoard of directorsShopping escortCommunity dining driverFundraising/ Event volunteerSeniors fitness instructor (WALC program)Volunteer fairs


Please indicate on what days and times you are available. For example: Tuesday afternoon, Wednesday evening, etc.)

I am available to begin

How often each week

Please explain any health issues that might affect your ability to volunteer

(allergies, injuries, and conditions)

Reference #1- (personal)

(Neighbour, friend)

Reference #1- phone number

Reference #1- email

Reference #2- (professional)

(Boss, Co-worker, Teacher)

Reference #2- phone number

Reference #2- email

Hobbies/ interests

(Cooking, Crafting, Dance, Fitness, Gardening, Graphic Design, Hiking, Knitting/Sewing, Photography, Painting, Reading, etc.)