Youth Volunteer Application

All information on this Volunteer Application form whether submitted online or in paper directly to Concordia Hospital will be entered to a website owned by Volgistics, Inc. and not the Concordia Hospital or the Winnipeg Regional Health Authority (WRHA).

Volgistics is a third party contracted to manage and store all information on volunteers collected by Concordia Hospital, including, but not limited to: this application, personal information, volunteer assignments, service hours, awards, etc. Volgistics currently stores this information on servers located outside of Canada. This information will be subject to the laws of the country where it is kept.

Concordia Hospital and the WRHA are not responsible for any lost or misdirected data or for any delays while data is being sent to or stored on the Volgistics website. Information about Volgistics’ Security Features, Privacy Policies and Terms of Use can be found on its website at website.
Contact Information
Title:*
- Mr.
- Ms.
- Mrs.
- Miss
Last Name:*
First Name:*
Address:*
Postal Code*
Phone:*
Business:
Mobile:
I prefer to receive calls at:
- Home
- Business
- Mobile
Best Time to Call:

: Hours

Minutes
Email:*

Have you volunteered before?
- Yes
- No
Volunteer Work
If possible, please list the last two organizations that you have volunteered for including: community clubs, schools, religious organizations, professional associations, non-profit organizations, sporting organizations, etc.
Organization #1
Your Responsibilities:
From:
YYYY dash MM dash DD
To:
YYYY dash MM dash DD
Reason for Leaving?
Organization #2
Your Responsibilities:
From:
YYYY dash MM dash DD
To:
YYYY dash MM dash DD
Reason for Leaving?
Have you ever applied to volunteer with this organization before?
- Yes
- No
If yes, when?

Education
Formal education is not required to be a volunteer. We welcome experience of all kinds.
High School:
Course of Study:
Start Date:
MM slash DD slash YYYY
End Date:
MM slash DD slash YYYY
Are you receiving credit for your volunteer work?
- Yes
- No
Required number of hours:
By when?
YYYY dash MM dash DD
For whom do you require the hours?

Optional
If you wish to have anything further to be taken into consideration when determining a volunteer placement, you may list those issues in the space provided.
optional

References
If you are interviewed as a potential volunteer, you will be asked to provide three (3) references.

Please note that references from family members or from personal friends will not be accepted, unless you were employed by them.
Authorization and Consent
For those applicants under the age of 18, parental / guardian consent will be required.

Please download and forward the completed Parent / Guardian Consent form.
Authorization:
By submitting this application, I agree that the information I have provided on the form is true and accurate. Furthermore, I understand and agree that submitting this application form does not automatically register me as a volunteer. It is the policy of the Concordia Hospital Volunteer Services to screen all prospective volunteers. While we try to place every prospective volunteer, management reserves the right to decline applicants who do not meet our requirements and/or placement criteria.
- I agree
- I disagree
Consent:
I consent to this information and information about my volunteer work with Concordia Hospital to be maintained on the Volgistics website and absolve and release Concordia Hospital and the WRHA from all and any liability that may otherwise accrue by reason of keeping this information on the Volgistics website and using this information for Concordia Hospital purposes.
- I consent
- I do not consent

Contact Information