Client and Patient Volunteer Training Application Form - fill out this form if you are interested in volunteering as a client & patient volunteer.  If you are interested in volunteering at the Office, Thrift Store or for one of our community events, please click the Volunteer tab above and select 'Volunteer Application'

 

* First Name
* Middle Name
* Surname
* Address
Address
City Postal/Zip Code
Country Province/State
* Home Phone
- -
Other Phone
- -
* Email
* Date of Birth
/ /
* Emergency Contact
* Emergency Contact Phone
- -
Other Phone
- -

Would you like to be added to the Chilliwack Hospice Society email list to receive information about upcoming education training and events?

* I agree
  • Yes
  • No

I grant permission for photographs/videos, written evaluation comments, or interviews to be used for educational purposes and/or to promote the Programs and Services of the Chilliwack Hospice Society.

* I agree
  • Yes
  • No
* Please describe any education and training that you have.

Formal education is not required to be a volunteer. We welcome experience of all kinds!

* Please describe any work and volunteer experience during the past five years.
* Have you ever applied to volunteer with this organization before?
  • Yes
  • No
If yes, when?
* Please check the areas of volunteer work you are interested in:
  • Hospice Team
  • Hospital Team
  • One-to-one Support
  • Caregiver Support
  • Bereavement Support
* Check any additional skills you have to offer:
  • Organizational
  • Arts & Craft
  • Photography
  • Musical Instrument
  • Facilitation Skills
Other Skills
* Check your main reason for volunteering:
  • Academic Credit
  • Employment Experience
  • Explore Careers
  • Learn New Skills/Knowledge
  • Give Back to the Community
  • Stay Active & Involved
Other reason for volunteering:
How did you hear about our Hospice Volunteer Programs and Services?
Are you available
  • Days
  • Evenings
  • Weekends

REFERENCES: 3 are required - 1 from your current or most recent employer/supervisor; and 2 people who are not immediate family and who have known you for at least three years.

Reference 1

* Name
* Relationship
* Phone Number
- -

Reference 2

* Name
* Relationship
* Phone Number
- -

Reference 3

* Name
* Relationship
* Phone Number
- -

Have you experienced the loss of a loved one in the past 12 months?

  • Yes
  • No
If yes, please explain
What are your thoughts and feelings about death?
Have you ever been with someone at the time of their death?

When thinking of your own death, what words best describe death to you?

  • I do not think about my own death
  • Sorrowful
  • Natural
  • Frightening
  • Painful
  • Lonely
  • Joyful
  • Heavy
  • Peaceful
  • Dark
Other
What do you feel are the strengths that you bring to your volunteer work?
Are there any challenges you anticipate that might impact you doing this work?

Code of Ethics for Volunteers

As a volunteer, I realize that I am subject to a code of ethics similar to that which binds the professional in the field in which I work. I, like them, assume certain responsibilities and expect to account for what I do in terms of what is expected of me. I understand that any information which is disclosed to me while volunteering with the Chilliwack Hospice Society is confidential.

I interpret "volunteer" to mean that I have agreed to work without compensation in money. I understand that I will be required to complete a police record check, meet with the Palliative Services & Education Coordinator and successfully complete the 30 hour volunteer training before being accepted as a Client and Patient Volunteer. It should be noted, however, that even after completion of the volunteer training, not everyone is accepted as a volunteer.

Declaration

I hereby certify that the statements made on this application are true and correct to the best of my knowledge. I understand that, by submitting this application I authorize enquiries to be made concerning my employment, character and public records for the purpose of determining my suitability as a volunteer. I agree to respect the confidentiality of any client information I acquire in the course of my volunteer activities with the Chilliwack Hospice Society.