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Ottawa-Carleton Association for


Persons with Developmental Disabilities (OCAPDD)
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General application
Name
Address
City
Province
Postal code
Home telephone
Work telephone
Fax
Email address
Emergency contact
Emergency contact Relationship
Emergency contact Tel Home
Emergency contact Tel Work
Languages
English
French
Sign
Bliss Symbols
Skills & Interests
Educational background
Current employer
Work experience
Hobbies, skills, interests
Previous volunteer experience Yes No
If yes, name of organization
Have you ever served as a volunteer with us before? Yes No
Name and telephone number
Preferences in volunteering
No preference
Working one-on-one with a single client (movies, walking, shopping, physical fitness, etc.)
Providing assistance to several clients
Driving clients
Swimming Assistant
Special occasions
Painting
Gardening
Silver Spring Farm Garlic Project
Christmas Gift Wrap
What are your hesitations, if any, to develop a relationship with a person who has a developmental disability?
Would you prefer Male or Female?
Would you feel comfortable being matched with an adult with limited to no verbal skills?
Do you have any physical disability or illness, which would need to be considered in any volunteer position? If yes, please specify:
Have you been immunized against Hepatitis B? Yes No
If there's a geographic area in which you'd prefer to do volunteer work, please indicate your prefererence here:
Do you have access to a vehicle that you can use for volunteer work? Yes No
 
References
Please list two non-family references that you have known for two years that we may contact.
1st reference
Name
Home telephone
Email address
 
2nd reference
Name
Home telephone
Email address
 
You heard about us from
a staff member
the Volunteer Center
a friend / volunteer
a client of the OCAPDD
the Volunteer Marketplace
other (please specify):
 
Authorization
Please check here if you agree to the following:
I, hereby give permission to the Ottawa-Carleton Association for Persons with Developmental Disabilities to contact the references listed in regards to my volunteer application. I understand that a police background and driving record check will be conducted as required.
 
Photo Release
Please check here if you agree to the following:
I hereby release any claims to all film, video audio or digital photos or recordings of / or involving myself, taken for publicity purposes and / or display opportunities for OCAPDD. This includes release of rights to broadcast, reprint, display, include in any brochure or promotional material, or for any other form of distribution or reproduction. Any of these visual or audio materials involving myself and/or others will become the property of OCAPDD.
 
Declaration
Please check here if you agree to the following:
I, hereby declare that the information provided on this form is correct to the best of my knowledge and I understand that any false statement may disqualify me from acceptance into the volunteer program.
 











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