Please ensure that you have reviewed the infomation on Southlake Website -- www.southlakeregional.org Volunteering Pages before completing the volunteer application.
Please complete all areas of the application. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED.
Fields marked with an * asterisk are required fields. If you do not wish to submit your application, you may exit this form at any time by closing your browser. All information will be lost. Southlake communicates via email. Please make Southlake Regional Health Centre a Safe Sender in your email program settings.

Youth Collaboration Council

Personal Information
First Name*
Preferred name
Last Name*
Home Address
City
Province
Postal Code
Phone Number*
E-mail Address*
Optional for statistic purposes only - Age group:
Please indicate if you are:
Emergency Contact Information
Name of Parent/Guardian
Relationship
Home Phone
Work Phone
Extension
Cell Phone
E-mail

Please tell us why you are interested in becoming a member of the Council (Check all that apply):
How did you hear about volunteering at Southlake Regional Health Centre? (Check all that apply)
Other
Other

Experience
Education
Are you currently attending school?
Yes
No
Recent Graduate
Name of School
Current Grade/ Level/Year
Volunteer Experience
Organization
Position
Year
Do you have any other activities that you are involved in (work, sports, clubs)?
What is something unique that you can bring to the council? i.e hobbies, interests, classes at school
i
Is there anything else we should know about you?
Have you or a family member ever accessed healthcare services?
Skills & Special Requests
Skills
Languages Spoken in addition to English
Special requests/needs
Comments regarding special requests/needs
Availability
Please indicate ALL times you are available to volunteer
Monday
7 am to 9 am
3 pm to 5 pm
5 pm to 7 pm
Tuesday
7 am to 9 am
3 pm to 5 pm
5 pm to 7 pm
Wednesday
7am to 9 am
3pm to 5 pm
5pm to 7 pm
Thursday
7am to 9 am
3 pm to 5pm
5 pm to 7 pm
Friday
7 am to 9 am
3 pm to 5 pm
5 pm to 7 pm
Other Times Available
Mode of transportation you use? Please check all that apply.

I confirm that:
I am 12 years old or older*
I have provided true & accurate information on my application*
I understand that:
  • The personal information collected in this application will be used as part of the application screening process to evaluate my suitability for a volunteer position at Southlake Regional Health Centre.
  • My personal information will not be used or disclosed for purposes other than those for which it was collected, except with the appropriate consent or as required by law. Personal information will be retained only as long as necessary for the fulfillment of those purposes or as required by law pursuant to the Public Hospital Act and the Freedom of Information and Protection of Privacy Act (FIPPA).
    Southlake Regional Health Centre places high value on the protection of personal information in compliance with legislation.
  • By typing my name below, I confirm that I have read and understood the information above.*
    Thank you for your interest in Volunteering at Southlake!