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Ontario

Referral Type:

New Referral

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Referral:

Volunteer Application Package ID

Date:

2026-09-29 19:32

Status:

Draft

Attachment(s):

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Attachment Type:

Contact Information

First Name

Last Name

DOB

Gender

Current Mailing Address

Address Line 1

Address Line 2

City

Location/County

Postal Code

Province

Home Phone / Cell Phone

Permission to call?

Work Phone

E-mail Address

Reason(s) for the referral

Referral Source

Emergency Contact

	First Name
	Last Name
	Relationship to Volunteer
	Home Phone
	Cell Phone
	Alternative contact

Criminal Record check with Vulnerable Sector

My criminal record check was completed on

I require a volunteer letter to get an updated criminal record check

Interests

Availability

Agreement and Signature

I understand that if I am accepted as a volunteer, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal.

Name (printed):

Signature:

Date:

Our Policy

It is the policy of this organization to provide equal opportunities without regard to race, color, religion, national origin, gender, sexual preference, age, or disability.

Thank you for completing this application form and for your interest in volunteering with us.

Media Release Consent and Confidentiality Agreement

Name:

Date:

There will be occasions when photographs and videos will be taken of staff and volunteers in our programs and activities. These could appear in our newsletters or brochures, local newspapers, various social media platforms and/or website. The staff and volunteers may also be mentioned by name.

I hereby give permission for theROC to take and use photographs for the media, various social media platforms and promotional materials at the discretion of theROC. I release theROC, its Officers, Directions, Coordinators, staff and volunteers from any and all responsibility/liability that may arise as a result of the use of such photos/media.

Signature:

As a volunteer, employee, or placement student of theROC, you may be privy to confidential information (written, verbal, or other form). This includes all information about members, clients, families, employees and other associate organizations, as well as any other information otherwise marked or known to be confidential.

I understand that any breach of the duty to maintain confidentiality could be grounds for immediate dismissal and/or possible liability in any legal action arising from such breach.

Signature: