Become a Volunteer

I certify that all information on this application is true and I give permission for Compass Community Health (Compass CH) to contact the above references. By signing below you give Compass CH staff permission communicate with you through the contact information listed above. Please note that Compass CH will not share your information outside of the Health Centre without your permission.

Volunteer Form

First Name *

Last Name *

Gender *

Program

Volunteer Role *

Home

Address Line 1 *

Address Line 2

City *

Province *

Country *

Postal Code *

Alternate

Alt Address Line 1

Alt Address Line 2

Alt City

Alt Province

Alt Country

Alt Postal Code

Your Information

Home Phone

Cell Phone

Email *

Reach You

Emergency Contact

Name

Number

Reference

Please complete with full names and addresses, two people who know you well enough to evaluate your qualifications as a volunteer. Include at least one previous and/or present employer, if applicable:

Reference 1

Name

Number

Relation

Reference 2

Name

Number

Relation

Get Involved

Become a Volunteer