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Volunteer Program Application

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Volunteer

Mission: To engage our community cooperative health and wellness.

First Name*
Last Name*
Address*
Street Address Address Line 2 City Province Postal Code
Email*
Phone 1*
Phone 2
Interests & Experience
I am interested in the following areas:*
Please select as many that apply.
- Food Preparation or Serving
- After School Youth Programs
- Parent and Child Drop-in Programs
- Community Relations - Access Visitor Guides
- Community Support, social services, resource centres
  (some experience and/or education required)
I want to volunteer because...*
I have experience or education in the following areas...
I have the following specialized skills or craft expertise...
Availability
Almost all volunteer times are during the day, on weekdays. Please indicate the times you are available.
*
- Select All
- Monday Morning
- Monday Afternoon
- Tuesday Morning
- Tuesday Afternoon
- Wednesday Morning
- Wednesday Afternoon
- Thursday Morning
- Thursday Afternoon
- Friday Morning
- Friday Afternoon
- Saturday Morning
- Saturday Afternoon
Reference #1
Reference 1: First Name*
Reference 1: Last Name*
Reference 1: Address*
Street Address Address Line 2 City Province Postal Code
Reference 1: Phone*
Reference 1: Email
Relationship to Reference*
Reference #2
Reference 2: First Name
Reference 2: Last Name
Reference 2: Address
Street Address Address Line 2 City Province Postal Code
Reference 2: Phone
Reference 2: Email
Relationship to Reference
Emergency Contact
Please provide an emergency contact for while you are at a volunteer shift.
Emergency Contact: Last Name*
Emergency Contact: First Name*
Phone*
CAPTCHA

Should you have any questions please contact:

Charlene Lipka
Community Facilitator
Phone (204) 938-5957
clipka@norwestcoop.ca

NorWest Co-op Community Health

785 Keewatin Street
Winnipeg, MB R2X 3B9
Phone: (204) 938-5900
Fax: (204) 938-5994

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