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    Personal Information

    Full Name

    First Name

    Last Name

    Contact Email

    Contact Phone Number

    Preferred method for correspondence

    Your Address

    Street address

    Street Address Line 2

    City
    Province
    Postal Code

    Date of Birth (yyyy-mm-dd)

    This information is not mandatory. Information regarding birthdates is collected to assist in planning and for securing funding for training and resources. i.e. some funding is available to specific age groups. It is personal information, and therefore is protected by privacy legislation. It will not be published or shared, except in anonymous aggregate forms when reporting to funders, authorities, or similar parties.

    Church affiliation (if applicable)

    Emergency Contact

    First Name
    Last Name

    Emergency Contact Email

    Emergency Contact Phone Number

    Emergency Contact - Relationship to you

    Skills and Qualifications

    Current or Past volunteer placement:

    Please check all skills/qualificiations/experiences that apply:

    What type of volunteer time commitment are you interested in?

    You can choose multiple.

    What do you feel will be the most rewarding part of the volunteer experience?

    As a method to communicate volunteer opportunities available in both Nanaimo and Parksville, our Volunteer Newsletter is distributed approximately once a month, and you are able to opt-out at any point.

    Information collected on this form will remain confidential to ICCS, and will only be shared with those individuals in our organization with a direct need to know it as part of the volunteer selection and placement process.

    By signing in the field below, you certify that the information provided above is true and accurate to the best of your knowledge, that you acknowledge how Island Crisis Care Society will use this information, and that you accept the terms listed above.

    Please sign in the field below with your mouse.