• Mandatory fields are noted with a star symbol *
  • Where there are multiple check boxes please select all those that apply.
  • If two or more individuals from your household are completing a volunteer form please ensure that you use your own personal email account for each. If you do not have a personal email account then please use your first name and last initial followed by @testemail.com - example: janed@testemail.com

Volunteer Information

Date of Birth: dd/mm/yyyy

Volunteers who attend our family bereavement retreat programs, who contribute their time at Kerry's Boutique and who participate at some of our events generally recieve a free Camp Kerry shirt and sometimes other cool attire. Providing us with your shirt-size will help ensure that orders are placed correctly.

As a volunteer with our organization what would you be interested in doing?

Volunteer Interests*
  • Assisting Children
  • Assisting Youth
  • Assisting Adults
  • Camp Kerry BC
  • Camp Kerry Ontario
  • Camp Kerry Atlantic Canada
  • Circles of Strength Burnaby Location
  • Circles of Strength North Vancouver Location
  • Peer Mentorship
  • Kerry's Boutique
  • Fundraising
  • Office/Administrative Support
  • Board/Committee Membership
  • Facilitating Presentations/Workshops
  • Research
  • Special Events

What volunteer experience do you have?

Volunteer Experience*

What motivates you at this time to volunteer with the Camp Kerry Society?

Motivation to Volunteer*

Tell us about your personal experience with death, grief & loss.

Personal experience*

What special qualities will you bring?

Volunteer Qualities*

The Camp Kerry Society contributes much of its success to the diverse skills and abilities of our volunteers who participate in variety of ways. Our unique programs have been recognized internationally and continue to expand as a result of their talents. Please identify your areas of personal expertise below so that we can provide you with a rich experience and pair your interests.

Volunteer Skill Set*
  • Acting/Drama
  • Animal Assisted Therapy
  • Art Therapy
  • Arts/Crafts
  • Body-centred/Relaxation Therapies
  • Bookkeeping/Accounting
  • Child Care
  • Computer Programming
  • Construction
  • Cooking
  • Counselling
  • Creative Writing
  • Dance
  • Database Entry
  • Donor Relations
  • Event Planning
  • Fashion
  • First Aid
  • Grant Writing
  • Graphic Design
  • Group Facilitation
  • IT Communications
  • Leadership Skills
  • Marketing
  • Music Therapy
  • Musician
  • Office Administration
  • Organizational Skills
  • Photography
  • Policy Development
  • Public Speaking
  • Retail
  • Science/Outdoor Education
  • Sports and Recreation
  • Videography
  • Website Administration
  • Yoga

When would you like to volunteer with us?

Volunteer Availability*
  • Days
  • Evenings
  • Weekends
  • Occasional
  • Ongoing
  • Project Specific

What are the best ways for us to contact you?

Communication Preferences
  • Email
  • Telephone

Two Personal References

Reference Name*
Reference Phone Number*
Second Reference*
Second Reference Phone Number*

Health Information

Care Card/PHN Number
Family Doctor Name
Doctor Phone Number
Emergency Contact: Name
Emergency Contact: Number
Emergency Contact: Cell Number
2nd Emergency Contact: Name
2nd Emergency Contact: Number
2nd Emergency Contact: Cell Number
Please list any medications that you currently use.
Please select any health issues that apply to you:
  • Allergies
  • Allergies: Penicillin
  • Allergies: Seasonal
  • Anxiety
  • Asthma
  • Bed-Wetting
  • Crohns/Colitis/IBS
  • Depression
  • Diabetes
  • Ear Infections
  • Eating Disorder
  • Epilepsy/Seizures
  • Fainting
  • Hearing Impaired
  • Heart Disease/Condition
  • Hepatitis
  • High Blood Pressure
  • HIV
  • Learn Differently (Learning Difficulty)
  • Mobility Impairment
  • Motion Sickness
  • Nightmares/Terrors
  • Nose Bleeds
  • Phobias
  • Pregnant
  • Sleep Apnea
  • Sleepwalking
  • Visual Impairment
  • Other
Please select any assistive devices that you use so that we can try to accomodate you better.
  • Asthma Inhaler
  • Cane/Walker
  • CPAP Machine
  • Dental Braces/Caps/Bridges
  • EpiPen
  • Glasses/Contacts
  • Hearing Aids
  • Insulin Dependent
  • Oxygen
  • Prosthetic Device
  • Wheelchair/Scooter

Describe any activities that should be restricted or discouraged due to health reasons.

Restricted Activities

Please describe any additional information about your health that could help the medical team and/or first responder assist you if necessary.

Health Notes

I agree to give permission for the nurse and/or qualified personal to administer prescriptions, over-the-counter medications, first aid and/or access to medical treatment, if needed.

Dietary Requirements

We provide food for our volunteers during our retreats/camps, support groups, and often at special events. Please indicate any dietary needs so that we can accommodate you better.

Allergies/Sensitivities/Requirements
  • Peanut Allergy
  • Other Food Allergy
  • Gluten-Free Diet Required
  • Lactose-Free Diet Required
  • Vegan Diet Required
  • Vegetarian Diet Required

If you selected "other", have a food allergy that is not mentioned, or if you have any other specific dietary restrictions and/or requirements then please explain.

Dietary Instructions/Information

Photo & Video Permission

In order to capture memories and document activities we frequently arrange for pictures and videos to be taken of participants in our programs and at events our organization is associated with.

 

These images/videos are generally utilized for a variety of purposes including; Promotion of the Camp Kerry Society, Educational Purposes, Project Evaluations, and most often they are shared amongst other fellow participants. These photographs and videos may also be used for external public viewing on our website and/or other platforms of social media, in promotional materials, and by news media for Camp Kerry Society related stories.

 

If you consent to have photo/video images of you used as noted above then please select the "Permission Granted" option below. If for any reason you don't want us to use your images/photos then please select "Permission not granted".

 

 

Acknowledgement of Risk & Release of Liability

In consideration for my own participation in the Camp Kerry Society Programs and/or events, I hereby release, hold harmless and indemnify the Camp Kerry Society, its members, officers, directors, employees, volunteers and independent contractors, from all liability, claim, causes of action of any kind whatsoever in respect to all personal injuries, loss of life or property losses which I may suffer arising out of the activities of the programs/events. That I do hereby acknowledge and agree that the activities such as those listed may be dangerous and expose me to risks and hazards: lifting & carrying supplies/equipment, participating in adventurous activities such as; swimming, hiking, climbing wall, ropes course, canoeing, kayaking, ball sports, campfire, horseback riding, fishing and that other activities designed to address grief and loss such as; sharing circles, memory services, and memorial activities, may elicit emotional discomfort. That I freely and voluntarily assume all of the aforesaid risks and hazards for myself (as well as my child(ren). That I have carefully read this release, waiver, and assumption of risk agreement, that I fully understand same, and that I am freely and voluntarily executing same. That I clearly understand that by agreeing to this release, I will be forever prevented from suing or otherwise claiming against the Camp Kerry Society, its members, officers, directors, employees, volunteers, or independent contractors with respect to any matter arising from these activities.

Staff and Volunteer Confidentiality Agreement

All individuals serving as Volunteers or Staff with the Camp Kerry Society are expected to respect the confidentiality rights of those receiving services through this organization. No person is to disclose confidential information on any “receiver” (One who is receiving programs/services from the Camp Kerry Society) to any person who is not either a staff person, a volunteer, coordinator, director, or a person specifically approved by the “receiver” either verbally or in writing.

 

Volunteers and staff are not to discuss confidential information concerning “receivers” in circumstances where a third-party may overhear the conversation. Volunteers and staff are encouraged to use initials or first names only when discussing situations involving a “receiver”. All documents and forms listing confidential information are to be safeguarded to the best of your ability.

 

Confidential information includes name, address, income, any forms that would have this information listed, any information received verbally from the “receiver” including financial, family, medical, or social information.

 

In consideration of my placement at any of the programs offered by the Camp Kerry Society, I acknowledge and agree to the aforementioned and the following:

 

  1. I understand that all personal information concerning staff, participants, and clients that receive services from the Camp Kerry Society is confidential and may not be communicated to anyone in any manner, except as authorized by the Executive Director, Dr. Heather Mohan, of the Camp Kerry Society.
  2. I understand that all information regarding the affairs of the Camp Kerry Society including financial, administrative, and medical records is confidential and may not be communicated or released to anyone in any manner except as authorized by the Camp Kerry Society’s Executive Director.
  3. I will not copy, alter, interfere with, destroy, or remove any confidential information or records except as authorized by the Camp Kerry Society.
  4. I understand that compliance and confidentiality is a condition of my placement with the Camp Kerry Society and that failure to comply may result in immediate termination of my placement, in addition to legal action by the Camp Kerry Society and others.

Criminal Record Check

To ensure the safety & wellbeing of our participants and guests we request that all adult volunteers provide us with a Criminal Record Check every five years. Different regions have different application procedures. Please contact our office coordinator for assistance if needed.

 

Once your record check has been completed please send us a copy by mail, fax or email.

 

Head Office Mailing Address:
Camp Kerry Society                                                              Phone: 604-553-4663
145 East Columbia Street                                                      Fax: 604-553-4664
New Westminster, BC                                                            Email: info@campkerry.org
V3L 3W2

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