DRAFT Crohn's and Colitis Canada Volunteer Application Form

Full Name *

First Name Last Name

E-mail *

Address *

Address 2

City / Town *

Province *

Postal Code *

Phone Number (home) *

- Area Code Phone Number

Phone Number (cell)

- Area Code Phone Number

Are you over the age of 18? *

Yes No

Preferred Method of Communication *

E-Mail Phone

I’d like to receive the “Talk about GUTS” quarterly e-newsletter

Yes, please add me. I can unsubscribe at any time.

Which option best describes you?

Employed Retired Seeking employment Student Other

Name of Employer/School

If under 18, what year were you born?

Does your Employer/School offer any of the following:

Donations for employee volunteers Matching charitable gifts Paid time off to volunteer Volunteer fairs/internal volunteer recruitment/promotion I'm unsure

How did you learn about our volunteer opportunities? *

Online volunteer posting (CharityVillage, GetInvolved.ca) Crohn's and Colitis Canada volunteer or supporter Crohn's and Colitis Canada website or event Volunteer Centre/Volunteer Fair Media: Radio or Newspaper Workplace or School

What is your connection to Crohn's and Colitis Canada? *

I have never volunteered or donated in the past I volunteered or donated in the past I currently volunteer or donate

What event did you volunteer for?

Why do you want to volunteer with Crohn's and Colitis Canada?

I have or know someone living with Crohn's or colitis Community Service program (high school, co-op) I'd like to share/develop my skills, expand my network Other- please elaborate

Other/Additional Reasons:

What skills do you have that you are interested in sharing with us?

PLEASE SELECT THE VOLUNTEER OPPORTUNITIES THAT YOU ARE MOST INTERESTED IN:

Short-term & Occasional Opportunities (one day, up to 3 months, project work, as needed/available)

Event Day Role (one day only - i.e. Gutsy Walk) Health Promotion (education, displays, public speaking) Group volunteering (corporate, faith, workplace, school, service club) Committee Role (planning Crohn's and Colitis Canada's fundraising and educational events)

Longer-term & Regular Opportunities (6 months - 1 year or more, weekly or a few times a month)

Being a leader in my community (leading a team of volunteers) Event planning & Fundraising (leadership role overseeing sponsorship, planning, event day) Marketing & Communications (social media, promotion, writing, design) Volunteer Engagement (recruitment, screening, recognition) Virtual/off-site roles (working online, requires a strong internet connection) Gutsy Walk Leadership (annual event taking place in June)

I am interested in volunteering for a: *

Short-term basis (one day, up to 3 months) Longer-term basis (6 months- 1 year or more) Occasional (project work, as needed/available) Regularly (weekly or a few times a month)

Availability *

Weekdays (9am-5pm) Evenings (6pm-9pm) Weekends Open/Changing schedule

I'd like to be contacted to discuss my skills and interests

Yes No

Interested in a specific role? Please list it here along with where you saw it posted.

Gutsy Walk (GW) takes place annually in June. If you are interested in volunteering for GW, please let us know your nearest location:

Please note: If you are interested in a GW event-day role ONLY, please ensure you have selected the 'Event Day Role' listed in the short-term opportunities menu above.

At Gutsy Walk, I'm interested in

an event day role ONLY (one day commitment) being an event day volunteer and maybe more being a committee member

Transportation

I have access to a reliable vehicle I have access to public transit I do not have my own method of transportation

I am fluent in the following languages

English French Other

If other, what language(s)?

Emergency Contact name *

Emergency Contact relationship (optional)

Emergency Contact phone number *

Emergency Contact evening phone number *

If under the age of 18, please obtain parental or legal guardian consent. Parent/guardian's name:

Have you ever been convicted of a criminal offense for which you have not received a pardon? *

Yes No

Volunteer Waiver: I grant Crohn’s and Colitis Canada permission to use any photographs or videotape images of me taken in the course of my involvement, and to use my name, image, comment(s) and information regarding my volunteer role, activities, affiliation and city of residence for the organization’s purposes in any media and territory in perpetuity. I waive and release any and all claims for myself, my heirs, executors and administrators against Crohn’s and Colitis Canada and any other sponsor or organization involved, from any and all claims or liability for death, personal injury or property damage of any kind however caused, including any claim or liability arising from the negligence of Crohn’s and Colitis Canada, its agents, servants, or employees and of any person on site, arising out of, or in the course of, my participation as a volunteer for which I choose to participate. This Release and Waiver extends to all claims, foreseen or unforeseen, known or unknown. During the continuance of my volunteer placement or any time after the termination thereof, I agree to keep confidential and not without the express written consent of Crohn’s and Colitis Canada disclose to any person or organization any donor, volunteer, financial, business or other proprietary or private information of Crohn’s and Colitis Canada which I may have acquired during the course of my volunteer or intern placement. *

(18 years and older) I have read and understood the waiver and am legally able to sign it (17 years and younger) I understand that before becoming an active volunteer, I must submit a waiver signed by my parent/guardian