Volunteer Application Should you require accommodation during the application process, please inform Fran Savelson at 905-827-8800 or 1-800-387-7127 x2329 so we can ensure your equal participation. Contact InformationName * Required First Last Email * Required Main Phone * RequiredOther Phone, please specify:Address * Required Street Address Address Line 2 City Province / State Postal / Zip Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Program ChoicesProgram Choice * RequiredMy FIRST choice would be:Bereavement SupportFriendly VisitingFriendly Visiting – CasualHome Support Exercise ProgramHospice CareMemory VisitingTele-TouchWellness Support - Reiki PractitionerWellness Support - Therapeutic Touch PractitionerAdult Day ProgramDementia Adult Day ProgramDementia Caregiver Support Group Facilitator * RequiredMy SECOND choice would be:Bereavement SupportFriendly VisitingFriendly Visiting – CasualHome Support Exercise ProgramHospice CareMemory VisitingTele-TouchWellness Support - Reiki PractitionerWellness Support - Therapeutic Touch PractitionerAdult Day ProgramDementia Adult Day ProgramDementia Caregiver Support Group FacilitatorNo second choice, I only want to volunteer for my first choiceCommunity * RequiredI can volunteer in the following communities: Burlington Halton Hills Milton Oakville Mississauga (Coptic Adult Day Program Only) Availability * RequiredI am available to volunteer: Weekday Mornings Weekday Afternoons Weekends Transportation * RequiredSome of our programs require transportation. Do you have access to a vehicle?YesNoVolunteer ExperienceCurrent Volunteer PositionsPlease list role and organization:Past Volunteer PositionsPlease list role and organization:Work ExperienceCurrent Work PositionsPlease list role and organization.Past Work PositionsPlease list roles and organizations.Skills and AbilitiesWhat languages do you speak?What are your interests, special skills and abilities?Other InformationYour ResumePlease upload your resume here. If you don't have it ready, don't worry! You can provide it at a later date. Drop files here or Have you been referred by an Acclaim Health volunteer or staff member?If so, please provide their name so we can thank them.PermissionsPermission to Email I agree Email is the main form of communication with our volunteers and it's how you will find out about upcoming workshops, events and major news regarding the organization. You can unsubscribe at any time, but this may result in you missing out on important stuff.Permission to Submit * Required I agree Acclaim Health is committed to individual privacy and has taken reasonable precautions to ensure the security of the information you are submitting through this online form. By clicking "I agree" you are acknowledging and accepting the potential risks inherent in submitting personal information and/or personal health information online. Please contact us by telephone at 905-827-8800 if you do not wish to submit this information online and we will be happy to assist you.CAPTCHANameThis field is for validation purposes and should be left unchanged.