Board members and more| Lutz Mountain Heritage Foundation Inc

POSITION TITLE

PERSONAL INFORMATION

Radio Field

New Application
Update Current Information

First Name and initial *

Birth year

Occupation

Last Name *

Gender

Male
Female

Place of Employment / School

What are your modes of transportation

I have a car
I can count on drives from relatives or friends
Public transportation
Walk / Bike

Reference 1 : Name and phone

Reference 2 (Name and phone number)

VOLUNTEER INFORMATION

Where did you hear about the Volunteer Centre?

Special needs

I have special needs
I do not have special needs

Describe below any special needs (e.g. transportation, wheel chair access, etc.) that you have before you can offer your resources.

Do you have volunteer experience?

Yes
No

Please indicate where, and what were your volunteering for

Do you have work experience?

Yes
No

Describe your work experience

Availability Sunday

Morning
Afternoon
Evening

Availability Monday

Morning
Afternoon
Evening

Availability Tuesday

Morning
Afternoon
Evening

Availability Wednesday

Morning
Afternoon
Evening

Availability Thursday

Morning
Afternoon
Evening

Availability Friday

Morning
Afternoon
Evening

Availability Saturday

Morning
Afternoon
Evening

Volunteer Job Categories

Other geographical preference

CONTACT INFORMATION

Street address

City

Province

Postal Code

Email* (mandatory) *

Phone *

Other Phone

OTHER INFORMATION

Checkbox Field (criminal)

I consent to the release of criminal records

Checkbox Field (vehicule)

I am willing to use my vehicle for volunteer purposes

Give below any comments of elaborations on your interests, preferences, etc.

If there is a community disaster (community recruitment of large number of volunteers) can we contact you to volunteer? *

Yes
No

Specific Application form

PERSONAL INFORMATION

VOLUNTEER INFORMATION

CONTACT INFORMATION

OTHER INFORMATION