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P.O. Box 486, Orillia, Ontario L3V 6K2
Tel: (705) 329-0909 Fax: (705) 329-2378
e-mail: info@AlzheimerOrillia.com
Volunteer Application Form
NAME:________________________ PHONE: home_____________ work_____________
ADDRESS:_____________________________________ POSTAL CODE:_____________
YOUR E-MAIL ADDRESS:______________________
1. Why do you wish to volunteer with the Alzheimer Society of North East Simcoe County?
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2. Do you have previous awareness of the effects of Alzheimer disease/related dementia?
YES NO If YES, please explain: ____________________________________________________
____________________________________________________________________________________
3. Have you previously worked with individuals with Alzheimer disease/related dementia?
YES NO If YES, please explain: _____________________________________________________
____________________________________________________________________________________
4. Please list any previous volunteer experiences you may have had:
Agency Position/Duties Date Served
_____________________________________________________________________________________
_____________________________________________________________________________________
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5. What are your current hobbies, interests, and/or special skills? ____________________________________
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