Survey - GEN_ON_Volunteer - Canadian Cancer Society

Volunteer involvement is based on the successful completion of further screening measures, and the availability of a suitable role. The Society will make available reasonable accommodations for people with disabilities upon request, please contact aoda@cancer.ca. If you are unable to complete the form online, please download the printable version and submit to your local community office.

Contact information:


	Title:
*	First name: Required
	Middle name:
*	Last name: Required
*	Email Required
*	Street 1 Required
	Street 2
*	City: Required
*	Province Required
*	Postal code Required
*	Phone number (10-digit number): Required
	Date of birth	Date of birth
	Yes, I would like to receive email from the Canadian Cancer Society about the Society, its impact, and other ways I can help. I can withdraw my consent at any time. More information about managing email preferences.
	Yes, I would like to receive postal mail from the Canadian Cancer Society.
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Question - Required - Emergency contact person:

*

Question - Required - Relationship:

*

Question - Required - Emergency Contact Home Phone Number:

Question - Not Required - Emergency Contact Cell Phone Number:

*

Question - Required - Preferred Contact:

*

Question - Required - Availability:

	Weekdays
	Weeknights
	Weekends

Question - Not Required - Other availability:

Question - Not Required - Current employment status (optional):

*

Question - Required - Please choose the community nearest you:

Question - Not Required - Area of interest: (Please check all that apply. You may also use the 'Other' box for additional comments)

	Fundraising in April for the Daffodil Month Campaign (selling daffodils or pins, canvassing door-to-door).
	Volunteering at a fundraising event on a committee or on event day (Relay For Life, etc).
	Helping out at the local office (administration, reception, data entry, etc).
	Promoting health living (education and awareness).
	Advocating for better public policies (letter writing, liaison with elected officials, etc).
	Providing direct support to those living with cancer (Transportation, Peer Support for Survivors/Caregivers).
	Being a leader in your local community (leading other volunteers, sharing your professional skills).
	Helping out but I'm not sure which opportunity is right for me.

Question - Not Required - Other:

(Maximum of 255 characters or about 5 rows of text)

Accessible Customer Service and the Accessibility for Ontarians with Disabilities Act (AODA)
Please read carefully before submitting.

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Question - Required - (Required)

I have reviewed and agree to the AODA Summary Information.

WAIVER
Please read carefully before submitting.

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Question - Required - (Required) Please choose one of the following options:

I am 18 or older and I have reviewed and agree with the contents of this waiver.

I am 17 or under and understand that I am required to submit the waiver signed by my parent or guardian in order to volunteer.