Emergency Contact 1

Emergency Contact 2

The employee is responsible for updating their own emergency contact information and must inform the Volunteer Coordinator of any changes to the emergency contact information listed.

In the event that I become ill or in need of assistance, Elder Help Peel has my permission to contact the names listed in this form.

Based on the volunteer position description and duties, would you like to identify any health conditions, allergies, limitations - physical, mental or otherwise that could assist staff in responding to a personal health emergency to protect your safety or the safety of others?

Onboarding Questions

Why you are interested in volunteering at Elder Help Peel?

What do you personally hope to achieve through volunteering?

Describe any relevant work or volunteer experiences and skills?

Volunteer Contract

I fully understand and agree to the following.

1. I will not be participating in volunteer activities and or assignments in the capacity of an EHP employee or independent contractor.

2. No pay, payment, salary, wages or employee benefits (such as accident/disability/medical/dental or other insurance coverage) whatsoever will be paid to me and I will not be covered by Workplace and Safety Insurance Board coverage.

3. I acknowledge that performing volunteer activities may involve certain elements of risk or the chance of an accident and I hereby release EHP and it’s elected officials, board members, officers, employees, and agents and their respective successors assigns, heirs, and executers from all claims for loss, damage, or injury, except for which that is caused solely by the negligence of EHP, it’s employees, agents or its independent contractors.

4. I will abide by all applicable EHP policies and rules, as may be amended from time to time, and will follow all instructions of the appropriate EHP management staff person in carrying out the volunteer activities and assignments.

5. I will not use facilities, equipment and property owned by EHP without the approval of an EHP management staff person.

6. I will not use facilities, equipment and property owned by EHP for personal purposes.

7. I will immediately notify the appropriate EHP supervisor or any incident that involves property damage or personal injury during my volunteer duties.

8. Either EHP or myself may terminate my volunteer activities at any time.

NOTE: This form must be completed and signed by the volunteer before being accepted by EHP for volunteer activities and assignments. The original is to be retained by the Volunteer Program Coordinator along with the signed Promise of Confidentiality, with a copy of each to be given to the volunteer.

Covid-19 Volunteer Waiver

I wish to volunteer my time and services to Elder Help Peel, hereby acknowledge that said organization is operating in an environment where COVID-19 or other communicable disease, virus or pathogen may be present and may present a risk to me and others. Therefore, I agree to follow local public health measures, Elder Help Peel policies and procedures to reduce the spread of COVID-19, or any other communicable disease, virus or pathogen.

I agree to immediately report to Elder Help Peel if I become symptomatic. I agree to voluntarily cease all activities should I become symptomatic until such time as my results are negative. I agree to permit Elder Help Peel to share this information between themselves and with Peel Public Health officials.

I understand that there is no medical health coverage or compensation available to me with regards to contracting COVID-19, or any other communicable disease, virus or pathogen during or as a consequence of my relationship with Elder Help Peel. I agree that Elder Help Peel will not be responsible to me for any potential exposure to COVID-19, or other communicable disease, virus or pathogen.

Covid-19 Volunteer Consent

This form acknowledges that Elder Help Peel has notified our volunteers and staff of our company policy regarding the protocols for COVID-19. This acknowledges that our clients have all rights to refuse new volunteers and or staff if they have travelled outside of Canada or are COVID-19 positive. Our volunteers have all rights to refuse volunteer assignments if they feel unsafe volunteering in COVID-19 environments.

Corresponding to Bill 175 - It is mandatory that all our staff are not cross-contaminating; meaning working in COVID or non-COVID environments in facilities and in community, traveling to other locations are permitted and our team will need to be notify immediately should this occur. It is important we are aware of your working situations and aware of all clients needs, as this is in the best practice.

Our company will ensure all PPE protocols are in place and follow up with our clients and staff on a regular, on-going basis to ensure everyone is safe, COVID-19 negative and have no signs and symptoms of COVID-19.

I confirm that I have not travelled outside of Canada within 30 days.

I confirm I have not tested positive for COVID-19 and have no signs and symptoms within 30 days. Should I experience any signs/symptoms I will notify my supervisor immediately.

Notice of Collection

Personal Information contained on this application form is collected pursuant to the Freedom of Information and Protection of Privacy Act, R.S.O. 1990, c. F.31 (as amended) under the authority of the Municipal Freedom of Information and Protection of Privacy Act, R.S.O. 1990, c. M.56, (as amended) and will be used to maintain volunteer records, to make placements, to compile a mailing list for Elder Help Newsletter, and for collection, creation, use and disclosure of personal information for the purpose of screening for volunteer assignments. Questions regarding this collection should be directed to, Coordinator of Volunteer Services; Elder Help Peel, 6 George St. South, Unit 2B Brampton, ON L6Y 1L9 Tel: 905-457-6055, Email: volunteer@elderhelp.net. I give my consent for my details to be processed as stated above for the purpose of volunteer recruitment.

Police Record Check Consent

Pursuant to the Criminal Records Act and s.42(b) of the Freedom of Information and Protection of Privacy Act, a satisfactory police check must be received by Elder Help Peel due to direct contact with elderly persons of the vulnerable population in Peel Region before the volunteer assignment can commence. To obtain a Police Record Check with Vulnerable Sector Search-Level Three, you must provide Police Services with an authorization letter confirming that you are applying for a volunteer opportunity. The letter will be provided to you by the Volunteer Coordinator. I hereby consent to provide the Elder Help Peel with a Police Record Check with Vulnerable Sector Search-Level Three to fulfill the requirements of the volunteer/applicant screening process.

Reference Check Consent

I authorize the Elder Help Peel, or its agent, pursuant to section 29(1) of the Municipal Freedom of Information and Protection of Privacy Act, to contact the person(s) and/or organization(s) for the purpose of obtaining reference information, including information in my personnel file(s). I certify that the reference information provided by me are true, complete and correct to the best of my knowledge. If the references cannot be contacted, I may be asked to provide additional references. I understand that any falsification of statements, misrepresentations, deliberate omission or concealment of information may be considered just cause for disqualification or dismissal from my volunteer assignment.

Consent To Name, Photography, Recording And /Or Publishing

I hereby give my permission to Elder Help Peel for use of my picture to issue a volunteer photo identification card and to use my picture and name, photographs, image, audio and video recordings taken during my time as a volunteer in any promotional material including advertising, brochures, publications, video productions, presentations, websites, social media and/or other uses. I waive the right to any fee or compensation for either the photographic sitting or the use or reproduction of the resulting photographs and name in any medium. I understand that these materials will be used to support the promotional efforts of Peel Elder Help and its programs and activities, and I understand that this authorization shall continue until terminated in writing.

Promise of Confidentiality

Parties. This Promise of Confidentiality applies to the volunteer, employee or contractor associated with and/or in the activities and or affairs of Elder Help Peel, a not for profit organization with a mailing address of 6 George St. South, Unit 2B Brampton, ON L6Y 1L9.

I acknowledge that I am aware that some of the information that I will handle or have access to in the course of my work as a volunteer, employee or contractor of Elder Help Peel is confidential. I further acknowledged that some or all of the information that relates to clients or employees of Elder Help Peel or members of the public cis confidential under the law, and is required to be kept confidential to protect the privacy of individuals to which the information relates.

AND I PROMISE THAT I will not disclose, communicate or convey or allow to be disclosed, directly or indirectly to any person who does not require such information in the course of their duties for Elder Help Peel, any private or confidential information whatsoever, obtained by me in or about the performance of my duties or by virtue of the position or employment as an employee, or placement volunteer for Elder Help Peel.

AND I FURTHER PROMISE THAT I will not allow any person or person not entitled by law to such information, to inspect or have access to any written statement, departmental record, roll, correspondence, plan, computerized record, document or any other paper of a private or confidential nature, and I will conscientiously endeavour to prevent any person to persons not entitled from inspecting or having access to any such confidential information.

Damages. Any Disclosure, misuse, copying or transmitting of any materials, data, or information, whether intentional or unintentional, will subject the Volunteer to disciplinary action, prosecution, and/or monetary damages according to the procedures set by the Elder Help Peel and any applicable laws.

Please read the following declarations carefully prior to signing below stating that you agree to the outlined declarations and submitting your application.

• I declare all the information provided on this form and in any other accompanying documents is complete and true in every respect.

• I understand failure to completely and truthfully answer the questions asked of me, when discovered, will constitute grounds for immediate rejection of my application or, if already accepted as a volunteer, immediate dismissal for just cause.

• I understand that all personal information which become part of this application will be regarded as confidential pursuant to the Freedom of Information and Protection of Privacy Act.

I have read, understood and agree to the above declarations.