Form
Your Information
Name
*
First
Last
Address
*
Street Address
Address Line 2
City
Postal Code
Email
*
Phone (Home)
*
Phone (Business)
Occupation
School
Emergency Contact
Name
*
Relationship
*
Address
*
Phone
*
Other Information
Interests
*
Fundraising
Feeding
Gardening
Palliative Care
Special Events
Computers/Wii
Friendly Visitor
Maintenance
Entertainer
Shopping Assistant
Cafe
Hairdressing Assistant
Office
Spiritual
Restorative Care
Life Enrichment Programs (ex: Crafts, Music, Games)
Check all areas of interest that apply
Hours and Days Available
Sunday
Morning
Afternoon
Evening
Monday
Morning
Afternoon
Evening
Tuesday
Morning
Afternoon
Evening
Wednesday
Morning
Afternoon
Evening
Thursday
Morning
Afternoon
Evening
Friday
Morning
Afternoon
Evening
Saturday
Morning
Afternoon
Evening
Personal References
Name
*
Address
Phone
Name
*
Address
Phone
I give permission for my photo to be used for GPH use
*
Yes
No
I understand all volunteers are required to have a Criminal Reference Check / Vulnerable Sector Screening before starting.
*
Yes
No
Declaration - Will participate in receiving annual influenza vaccination
*
Yes
No
Influenza vaccinations are available annually and will be supplied by Grove Park Home
Declaration - Have received a complete series of the COVID-19 vaccination (2 doses). Proof of vaccination will be required prior to start date
*
Yes
No
While required for entry into long-term care
I hereby authorize the individuals that I have listed as references to provide any and all information to Grove Park Home, and I release Grove Park Home from any liability that may result from this discolosure
*
Required
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Careers
Located at
234 Cook Street
Barrie, ON L4M 4H5
Call us anytime
(705) 726-1003
Email us at
info@gp.mcstaging.in
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Long-Term Care
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