Volunteer Application Form

Contact information:
First Name: _____________________________ Last Name: ___________________________________
Chosen Name or Nickname: _________________________________________________
Pronouns you prefer to use: SHE/HER HE/HIM THEY/THEM Other:__________________
Address: __________________________________________________________________________________
City: ___________________________________ Postal Code: __________________________________
Cell Phone: _______________________________ Are you okay with texting information? YES / NO
Alternate Phone: ___________________________ Email Address: _____________________________

Leave blank

Personal Information:
Languages spoken or written: _______________________________________________________________
Date of Birth: Month/Day/Year _______________________________________________________________
Age range: Please select one UNDER 18 18-35 OVER 35
Can you Sit or Stand for up to 3 hours at one time? YES / NO
Can you lift up to 40 lbs or 18 KG? YES /NO
Emergency Contact Information:
First Name: _____________________________ Last Name: ___________________________________
Phone Number: _________________________ Relationship: _________________________________
Alberta Health Care number: ________________________ Name of Doctor ____________________________
Please list any medical conditions, allergies, or anything else that EMS staff should be aware of:
__________________________________________________________________________________________

7555 Falconridge Blvd NE #10, Calgary, AB T3J 0C9

Your Interests:
How did you hear about us? How did you find out about the Volunteer opportunities?
__________________________________________________________________________________________
__________________________________________________________________________________________
Which organizations are you most interested in Volunteering for? Please Circle your preference
Genesis Centre Trellis Society The Calgary Food Bank Any Organizations
As a Volunteer you may be working with Youth, Children, Seniors, New-comers, and the Differently-abled.
Will you be comfortable working with all groups, and can you pass a Vulnerability Police check? YES / NO
What positions/roles are you most interested in? __________________________________________________
Which days and hours are you most likely to be available to help as a Volunteer? Type x into the boxes below:
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
8am - 10am
10am - 12pm
12pm - 2pm
2pm - 4pm
4pm - 6pm
6pm - 8pm
On average how many hours/ day are you interested in volunteering? _________________________________
On average how many days/ week are you interested in volunteering? ________________________________
Why do you want to volunteer at the Genesis Centre? ______________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Please provide references that can be called. These are people who can vouch for your good character.

First Name: _____________________________ Last Name: ___________________________________

Phone Number: _________________________ Relationship: _________________________________

First Name: _____________________________ Last Name: ___________________________________

Phone Number: _________________________ Relationship: _________________________________

7555 Falconridge Blvd NE #10, Calgary, AB T3J 0C9

 DECLERATIONS, RELEASES, ACKNOWLEDGEMENTS AGREEMENTS AND POLICIES :
NORTHEAST CENTRE OF COMMUNITY SOCIETY ("The Genesis Centre”).

1. DECLARATION OF CONFIDENTIALITY
WHEREAS during the course of his or her employment/volunteer experience with The Genesis Centre, the
Employee/Volunteer will have access to information which is confidential, and The Genesis Centre wishes
that such information remains confidential.

For the purposes of this Agreement, "Confidential Information" means any and all information provided by, or
on behalf of, The Genesis Centre to the Employee/Volunteer, together with all information provided by any
other party to the Employee/Volunteer, if such information in any way relates to The Genesis Centre and their
respective businesses, suppliers and customers, including without limitation: (a) existing and prospective
business opportunities, including all ventures considered by The Genesis Centre; (b) customer information,
customer names, addresses, contacts, details of pricing, marketing and supply strategies and prospect lists; (c)
supplier information, including supplier names, addresses, contacts and details of supply contracts; (d)
information regarding the compensation provided by The Genesis Centre; and (e) financial information,
including the business plans (including the Strategic Plan for The Genesis Centre), financial statements and
accounting records of The Genesis Centre; provided however that Confidential Information shall not include
information: (a) already possessed by the Employee/Volunteer prior to his or her employment/volunteer
experience at The Genesis Centre; (b)independently received by the Employee/Volunteer without obligation or
confidence from a third party; or (c) required to be disclosed pursuant to law or an order from a court of
competent jurisdiction.

Any Confidential Information received by the Employee/Volunteer shall be kept in confidence and not used for
any purposes other than in the course of his or her employment/volunteer experience and shall only be
disclosed to others as required for the Employee/Volunteer to carry out his or her employment/volunteer
duties. Any disclosure to an individual or organization outside of The Genesis Centre which is required as part
of the Employee's/Volunteer’s duties shall only be done in compliance with The Genesis Centre's policies and
procedures relating to the disclosure of confidential information to third parties. The Employee/Volunteer shall
take all reasonable precautions to maintain the confidentiality of the Confidential Information and use the
Employee's/Volunteer’s best efforts to prevent any person from making unauthorized use of the Confidential
Information.

Immediately upon termination of the Employee’s/Volunteer’s employment/experience at The Genesis Centre

for any reason, or at any time upon demand of The Genesis Centre, the Employee/Volunteer shall return or
supply to The Genesis Centre any of the Confidential Information in the Employee's/Volunteer’s possession or
control and any analysis or derivative work relating to the Confidential Information, and no copies of the
Confidential Information, analysis or derivative work shall be made or retained.

If the Employee/Volunteer is requested or becomes legally compelled to disclose any Confidential

Information, the Employee/Volunteer shall provide The Genesis Centre with prompt written notice of same

7555 Falconridge Blvd NE #10, Calgary, AB T3J 0C9

so that The Genesis Centre may, at their option, seek a protective order or obtain reliable assurances that
the Confidential Information will be accorded confidential treatment.

The obligations of confidence and restrictions on use in respect of Confidential Information in this Agreement
shall continue for so long as the Confidential Information is or remains confidential and shall survive the
termination of the Employee’s/Volunteer’s employment/experience for any reason.

This Agreement is governed by the laws in force in the Province of Alberta, Canada and is the entire
agreement between the parties concerning the subject matter hereof and may only be changed by a
written agreement signed by both parties hereto.

2. DECLARATION OF CRIMINAL RECORD CHECK (CRC) & INTERVENTION RECORD CHECK (IRC)
The Genesis Centre requires a satisfactory Intervention Record Check (IRC) and Criminal Record Check (CRC) prior to an
employee/volunteer working alone in the Agency. New employees/volunteers who have not yet produced clear IRC’s
and CRC’s will be asked not to work or to work under direct and constant supervision (i.e., never alone. If a record (you
have not declared) reveals a non-clear status, it may lead to immediate termination of employment/placement. In
addition, should you be charged with a criminal offense or be the subject of a Child and Family Services investigation
while employed by (or while volunteering with) The Genesis Centre you are obliged to IMMEDIATELY inform the Agency.
Failure to do so will result in disciplinary action up to and including termination. Your signature below indicates that you
agree to adhere to this policy CLEAR RECORD CHECKS

To my knowledge, I declare that: I do not have a criminal record and my Criminal Record Check (CRC) will indicate this. I
have never been in a position to put a child at risk or to be perceived as putting a child at risk and my Intervention
Record Check (IRC) will indicate this.

3. MEDIA RELEASE
I hereby give permission to The Genesis Centre to use my name, any photo or video images of me and comments made
by me in writing or otherwise, for promotional purposes, in any form of media in relation to The Genesis Centre
promotional materials (i.e. video, radio, print, website, press release). I understand that by signing this document it does
not guarantee publication of my name, any photo, video image or comments I make. I understand there will be no
compensation, remuneration for the use or the reuse of my name, any photo, video image or comments. I understand I
am under no obligation to sign this form, and by not signing I will still be able to fully participate as an employee or
volunteer with The Genesis Centre.

4. RISK ACKNOWLEDGMENT & MEDICAL INFORMATION RELEASE

Our Goal is to provide a safe experience for all volunteers taking part in programs offered by The Genesis Centre. Our
programs, however, may include elements of risk. We believe in the informed consent of the participant(s) and/ or legal
guardian of the participant(s) to the identifiable and unforeseen risks that may occur during our programs.

RISK ACKNOWLEDGEMENT Risks or dangers identifiable and unforeseen in the programs at The Genesis Centre may
include loss and/or damage of personal property, injuries may occur when you volunteer in activities such as sports
programs, dance, inclement weather , allergies (food, plant) , insect bites, and any other possible risks. There are also

7555 Falconridge Blvd NE #10, Calgary, AB T3J 0C9

other risks inherent and unforeseen when traveling to and from a program outing which may include mishaps during
transportation I have read and clearly understand that there are identifiable and unforeseen risks or dangers to the
program and The Genesis Centre.

Signing up to volunteer is your acknowledgement and acceptance of the risks or dangers that may occur during the
program and thereby you and/or as the parent(s) or legal guardian(s) of volunteers are deemed to have accepted the
risks or dangers of this program. In consideration of my, and/or my child (ren) or charges participation in this program I
agree and acknowledge that: My child(ren) or charge(s) and/or I have met all of the prerequisites required for
volunteering in programs offered by The Genesis Centre. I freely voluntarily release and discharge The Genesis Centre,
its employees, Directors, officers, agents, instructors, volunteers, counselors and leaders from all claims demands,
actions or causes of action for damages, property loss or personal injury except in the case of negligence as defined by
law, on the part of The Genesis Centre. I waive any claim I may have against The Genesis Centre arising from my and/or
my child(ren) or charge(s) participation in the program and I will indemnify and save harmless The Genesis Centre, its
employees, Directors, officers, agents, instructors, volunteers, counselors and leaders for any claim, except negligence
as defined by law on the part of The Genesis Centre. I agree that by signing this Risk Acknowledgement, Release of
personal and medical information, and release, waiver of claim and assumption of Risk as a parent or guardian of a
participant who is under the age of 18years. I acknowledge that there are risks and hazards inherent in the program to
which I am willing to expose my child or charge and I will pay for any costs incurred by The Genesis Centre should a suit
be launched on my child’s or charges behalf , except in the case of negligence as defined by law on the part of The
Genesis Centre. The Genesis Centre, its employees, Directors, officers, agents, instructors, volunteers, counselors and
leaders may collect, use retain, and disclose my child(ren) and/or charge(s) and my personal information where in its
sole discretion, it deems necessary and reasonable for the purpose of a safe and caring experience for the participant.
For example, disclosure of personal information to third parties may occur in the event of accident, sickness, counseling,
program assessment, legal proceedings and investigation or preparation of tax receipts. The retention period for this
personal information is seven (7) years from the date of collection. In the event of program evaluation, aggregate data
not personally identifiable information will be collected and disclosed. The Genesis Centre may secure such medical
advice and services as it in its sole discretion may deem necessary for my and/or my Childs or charge(s) health and
safety and I shall be financially responsible for such advice and services that exceeds coverage by Alberta Health Care. I
realize that a reasonable effort will be made to contact the primary contact person and/or emergency contact person if
an emergency arises and if not available then as soon as is reasonable possible.

5. WORKPLACE HARASSMENT

The employees, volunteers, and customers of The Genesis Centre are entitled to an environment
free from discrimination, violence, or harassment.

Every member of the organization is responsible for maintaining the highest standards of personal conduct and
for ensuring that members of the organization can carry out their assigned duties in an environment that is
free of discrimination and harassment. We are expected to treat each other with respect and dignity, and act
with courtesy and tolerance.

Under the act, every person has a right to equal treatment in employment without discrimination based on
the following protected grounds: Race, Religious beliefs, Colour, Gender, Gender identity, Gender expression,

7555 Falconridge Blvd NE #10, Calgary, AB T3J 0C9

Physical disability, Mental disability, Age, Ancestry, Place of origin, Marital status, Source of income, Family
Status, Sexual orientation

What Is Harassment?
Harassment consists of any abusive or unacceptable comments or conduct related to a ground of
discrimination that is known, or ought reasonably to be known, to be unacceptable.

• Harassment can be expressed in several ways, such as, unwanted advances, suggestive or
aggressive remarks, racial or ethnic slurs, or practical jokes, that result in humiliation.
• Sexual harassment consists of any conduct, comment or contact of a sexual nature that is likely to
cause offence or humiliation or that might, on reasonable grounds, be perceived as placing a
condition of a sexual nature on employment or opportunity for training or promotion. The conduct,
contact, or comment need not be deliberate or conscious and will be assessed according to the
accepted standards of reasonableness.
• Employees are protected against harassment under the Act on any of the protected grounds
(mentioned above).
• A legitimate management action, i.e. performance management, however, is not considered
harassment.

Zero Tolerance for Violence

As per Alberta Occupational Health and Safety Act (AHSC), “whether at a work site or work related,”
violence is defined as, “the threatened, attempted, or actual conduct of a person that causes or is likely
to cause physical injury.”

In this policy, violence and threats of violence include, but are not limited to:
• Any act of physical assault
• Verbal assault
• Threats and attempts to intimidate
• Throwing of articles in a deliberate or aggressive manner
• Aggressively approaching another individual
• Striking another individual
• Attempting to goad or incite violence in others

Procedures for Dealing with Discrimination, Violence, or Harassment

If you believe that you have been discriminated against or harassed in your work with The Genesis Centre or a
customer, you should follow the steps outlined in the policies and procedures manual

6. VOLUNTEER / PRACTICUM STUDENT AGREEMENT

7555 Falconridge Blvd NE #10, Calgary, AB T3J 0C9

We thank you for your interest in volunteering with The Genesis Centre. It is because of volunteers that we are able to
offer our services and programs to children, youth and families across the City of Calgary. For a better understanding of
what you can expect as a volunteer and what is expected of you by our organization, please read the following:

As a volunteer/practicum student you can expect:

• To be treated as an equal partner in our mission

• Be matched to a volunteer opportunity that best suits your skills and interests
• Provided with an orientation that is specific to your role and the programs/services we provide
• Continuous on the job training and learning opportunities
• A workspace that fosters collaboration, respect, and openness
• Sound guidance, communication, and support from staff
• Opportunities to express your opinions and ideas
• Feedback on the work you have been conducting
• Opportunities to be involved with a variety of activities
• Recognition of your generous contributions

As a volunteer we expect that you will:

• Assist us in providing the best possible experience for the children, youth and families who access our services
• Choose a volunteer opportunity that best suits your skills, interests and time • Recognize and respect the boundaries
of staff, volunteers and program participants
• Follow through with your volunteer commitment (i.e. being on time, calling if you are going to be sick)
• Maintain confidentiality when presented with sensitive information
• Be a positive role model to the children, youth and families we serve
• Adhere to all policies and procedures of the volunteer program
• Work as a positive and contributing member of our team
• Provide timely and honest feedback to staff about your volunteer role and the programs/services we provide
• Act in a professional manner when representing The Genesis Centre
• Have fun and enjoy yourself!

7555 Falconridge Blvd NE #10, Calgary, AB T3J 0C9

By signing this document I am declaring that I have read and understand the information above, and I will strive to fulfill
my part of the Volunteer Agreement. I HAVE READ CAREFULLY READ UNDERSTAND AND I AM FREELY SIGNING
1. The Confidentiality Agreement,
2. Declaration of Criminal record check,
3. Media Release,
4. Risk Acknowledgement Waiver of Claim and Assumption of Risk and medical information release,
5. Workplace Harassment Policy
6. Volunteer / Practicum Student Agreement

I voluntarily accept and assume the risks of dangers inherent, identifiable and /or unforeseen while volunteering and
with The Genesis Centre, including personal injury and property loss, except in the case of negligence as defined by law
on the part of The Genesis Centre.

This Agreement is governed by the laws in force in the Province of Alberta, Canada and is the entire
agreement between the parties concerning the subject matter hereof and may only be changed by a
written agreement signed by both parties hereto.

IN WITNESS WHEREOF the parties have signed this Agreement as of the date first written above.

Volunteer Name Volunteer Signature

Date (mm-dd-yyyy)

7555 Falconridge Blvd NE #10, Calgary, AB T3J 0C9