YORK REGION
Volunteer Application Form

St. John Ambulance is seeking volunteers to help in the community of YORK REGION, Ontario.

Please fill in your contact info below, let us know which division you are interested in volunteering and answer a few simple questions to help us serve you better. For FIRST AID & CPR TRAINING questions, please contact us HERE

What VOLUNTEER DIVISION of St. John Ambulance would you be interested in joining? *

MFR Medical First Response (Age 16+)

YOUTH Services (Ages 12~17+) UPDATED

THERAPY DOG Services (Age 18+)* (16+ In Special Circumstances)

CAR SEAT CLINIC Services (Age 16+)

OUTREACH & Education (Age 18+)

How many children are your registering in our Youth Program? *

1

2

3

Joining as a NEW Youth Leader Over 18+ ?: *

YES

NO

Have you PREVIOUSLY volunteered with St. John Ambulance? *

YES

NO

- - Previouse SJA Volunteer Experience (Transfer) - -

(ONLY complete if your answered YES to being a member of SJA)

Which BRANCH did you volunteer with?
(Branch Name) *

What kind of VOLUNTEERING did you do at the previous branch? *

Other VOLUNTEERING at prevouse branch
(Please Describe) *

Branch City? *

Branch Province? *

How LONG ago?
(Years) *

How LONG have you volunteered with SJA?
(Years) *

Do you know your ALLIANCE ID? *

Yes

No

ALLIANCE ID #

Could you give a brief reason for Branch MOVE -or- WHY you are returning?

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

- - - - - - - - - - - YOUTH 1 - - - - - - - - - - -

What is the AGE of your Child / Young Adult -or- Participant?
(Years? - Requred for Program Placment) *

PLEASE NOTE:

Our YOUTH PROGRAM has changed. Unfortunately, we CANNOT compete this enrolment.

With the National rollout of the NEW SJA Connect Youth Program, participants must be 12 Years or older to join the St. John Ambulance Youth Program.

We are very sorry for the inconvenience this may have caused as we are currently updating our website and marketing materials.

(Issued by St. John Ambulance, Council for Ontario)

GREAT! You are 12+ Years or older:

Our YOUTH PROGRAM has changed. With the National rollout of the NEW SJA Connect Youth Program, youth participants may join our St. john Ambulance Youth Program starting from the age of 12 Years but 14 Years or older youth will ALSO be part of our St. John Ambulance NEW SJA Connect Youth Program.

Please CONTINUE completing this form so that we can enrole you in our youth program in a York Region area closest to where you live.

(Issued by St. John Ambulance, Council for Ontario)

Participants FIRST Name *

Participants LAST Name *

Participants HOME Phone # *

Participants CELL Phone #

Best TIME to Contact by Phone? *

Can Your Phone Receive TXT Messages? *

Participants E-MAIL Address *

- - - - - - - - - - - YOUTH 2 - - - - - - - - - - -

Y2 - Participants FIRST Name *

Y2 - Participants LAST Name *

Y2 - What is the AGE of your Child / Young Adult -or- Participant?
(Years? - Requred for Program Placment) *

PLEASE NOTE:

Our YOUTH PROGRAM has changed. Unfortunately, we CANNOT compete this enrolment.

With the National rollout of the NEW SJA Connect Youth Program, participants must be 12 Years or older to join the St. John Ambulance Youth Program.

We are very sorry for the inconvenience this may have caused as we are currently updating our website and marketing materials.

(Issued by St. John Ambulance, Council for Ontario)

GREAT! You are 12+ Years or older:

Our YOUTH PROGRAM has changed. With the National rollout of the NEW SJA Connect Youth Program, youth participants may join our St. john Ambulance Youth Program starting from the age of 12 Years but 14 Years or older youth will ALSO be part of our St. John Ambulance NEW SJA Connect Youth Program.

Please CONTINUE completing this form so that we can enrole you in our youth program in a York Region area closest to where you live.

(Issued by St. John Ambulance, Council for Ontario)

Y2 - Do they have their own CELL Phone #?
(Not Mandatory)

Y2 - Do they have their own E-MAIL Address?
(Not Mandatory)

- - - - - - - - - - - YOUTH 3 - - - - - - - - - - -

Y3 - Participants FIRST Name *

Y3 - Participants LAST Name *

Y3 - What is the AGE of your Child / Young Adult -or- Participant?
(Years? - Requred for Program Placment) *

PLEASE NOTE:

Our YOUTH PROGRAM has changed. Unfortunately, we CANNOT compete this enrolment.

With the National rollout of the NEW SJA Connect Youth Program, participants must be 12 Years or older to join the St. John Ambulance Youth Program.

We are very sorry for the inconvenience this may have caused as we are currently updating our website and marketing materials.

(Issued by St. John Ambulance, Council for Ontario)

GREAT! You are 11+ Years or older:

Our YOUTH PROGRAM has changed. With the National rollout of the NEW SJA Connect Youth Program, youth participants may join our St. john Ambulance Youth Program starting from the age of 12 Years but 14 Years or older youth will ALSO be part of our St. John Ambulance NEW SJA Connect Youth Program.

Please CONTINUE completing this form so that we can enrole you in our youth program in a York Region area closest to where you live.

(Issued by St. John Ambulance, Council for Ontario)

Y3 - Do they have their own CELL Phone #?
(Not Mandatory)

Y3 - Do they have their own E-MAIL Address?
(Not Mandatory)

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

Are you OVER the age of 18 years?
(Participants under 18 years old require parental permission) *

Yes

No

- - - Complete if PARENT / GUARDIAN - - -

(YOUTH Program -or- *THERAPY DOG Participants under 18yrs in spcial circumstances)

Parent / Guardian FIRST & LAST Name *

What is the AGE of your Child / Young Adult?
(Years? - Requred for Program Placment) *

Parent / Guardian HOME Telephone # *

Parent / Guardian CELL Telephone #

Parent / Guardian E-MAIL Address *

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

Want to keep connected with St. John Ambulance? Our E-mail Updates.

- - THERAPY DOG Specific Questions - -

(ONLY complete these questions if seeking THERAPY DOG volunteering)

WEEKDAY Availability to Complete THERAPY DOG Visits?

WEEKEND Availability to Complete THERAPY DOG Visits?

Name Of Your Dog? *

Breed of Dog? *

Dog Gender? (F/M) *

Your DOG must be 1-YEAR OLD to be eligible to enroll in our THERAPY DOG Program

Age of Dog?
(Years) *

Spayed / Neutered? (Y/N) *

All Vaccinations Completed? (Y/N) *

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

What region area do you live? *

Area you wish to volunteer within? *

What EVENINGS of the week are you consistently available for weekly meetings?
(Applies to MFR & YOUTH Services Branches) *

Monday <-- New MFR volunteers for first 12 weeks

Tuesday

Wednesday

Thursday <-- Youth Program meeting nights

Where did you find out about this opportunity? *

Comments / Additional Information

YORK REGIONVolunteer Application Form

YORK REGION
Volunteer Application Form