Volunteer Form

Your Name: (required)

Address:

Postal code:

Telephone
Home:
Cell:
Work:

Your Email: (required)

Best time to call: ampmevening

Date of birth:
(While this is optional, it will help us greatly in compiling our statistics)

Age range: 18-2425-3435-4950-6465-7475+

Languages
Spoken: EnglishFrench   Other:
Written: EnglishFrench   Other:

Education: High-schoolUniversityPost-graduate

Experience and skills
Describe your work experience

Describe your volunteer experience

Describe any specific skills or hobbies which would be useful to your work as a volunteer
(also make note of any computer skills)

Cancer experience
Cancer diagnosis
   Date:
   Diagnosis:

Diagnosis of family member(s)
   Date:
   Diagnosis:
   Date:
   Diagnosis:
   Date:
   Diagnosis:

Diagnosis of a close friend
   Date:
   Diagnosis:

No experience

Other

Chemo - What type?HormonalRadiotherapy
What was the experience like? Describe your experience (treatments, outcomes, etc.)

Have you lost a family member or close friend to cancer? If so, when:
Please describe your experience of this loss?

Motivation - Please describe how you heard about Hope & Cope and your reasons for applying to volunteer in the program.

Coping - What helped you to cope with the difficult issues related to your personal experiences with cancer? And/or with your experiences with loss?

Please describe the strengths you feel you have for volunteer work in this program.

As this is an understandably difficult area in which to work, please describe any concerns you have and the help you feel you would need to work effectively.

Please give the name and phone numbers of THREE references (either personal or professional)
            Name:
           Phone:
Relationship:
            Name:
           Phone:
Relationship:
            Name:
           Phone:
Relationship:
Permission for police check: YesNo

Please indicate the day / schedule you hope to follow
(prioritize your 1st and 2nd choices)

First choice
Mondayampmevening
Tuesdayampmevening
Wednesdayampmevening
Thursdayampmevening
Fridayampmevening
Saturdayampmevening
Sundayampmevening

Second choice
Mondayampmevening
Tuesdayampmevening
Wednesdayampmevening
Thursdayampmevening
Fridayampmevening
Saturdayampmevening
Sundayampmevening

Please select the areas in which you are interested in volunteering
Hospital VisitingPalliative Care Volunteer Program (4Main)Peer Counselling / MentoringOncology / Radiotherapy ClinicsSelf-Help Group FacilitatorPR and/or Education of Volunteers & PublicOffice - TypingOffice - Familiar with computersOffice - Familiar with data base entryDeveloping and Updating Resource Information & Educational ToolsLibraryCoping Skills TrainingComplementary Therapies - Relaxation Training, Art Therapy, Yoga, Qi Gong, Massage, etc.Bereavement ProgramNewsletter publicationWebsite developmentWellness Centre - Exercise, Nutrition, Office Reception, Registration, etc.Fundraising - Friends of Hope & CopeFundraising - Young Adult Division (Denim & Diamonds)Fundraising - Other


Confidentiality
I will respect the right of the patients and their families to strict confidentiality concerning; the diagnosis, prognosis, family dynamics and any information of a medical, spiritual or psycho-social nature. This information is shared with me as part of a sacred trust and I will divulge none of it to others.

Training and on-going learning
I will attend the Hope & Cope orientation sessions, the McGill training program for Palliative Care volunteers (if applicable) and attend educational programs arranged for volunteers within the department, as part of my commitment to continuous on-going learning.

Respecting the schedule
I will respect the schedule arranged for me during my probationary period in order to shadow my partner, and keep to the schedule which I later establish in collaboration with the Volunteer Coordinator. I will notify theVolunteer Coordinator of any change of schedule, within a reasonable delay, and attempt to find a replacement volunteer for my shift.


I have read and acknowledge the above terms:

3 days ago

Hope & Cope

Lise and Barbara, long-time members of Hope & Cope's Office Team, share an easy camaraderie as they assemble nursing kits for the Oncology Department. Thanks, Ladies, for all that you do!

Les bénévoles comme Barbara et Lise méritent toute notre reconnaissance !
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5 days ago

Hope & Cope

Breast cancer survivor Diane Forget speaks from the heart about the wonderful camaraderie and support she has found here at the Hope & Cope Cancer Wellness Centre.

La survivante du cancer du sein Diane Forget parle avec tout son coeur de la merveilleuse camaraderie et de l'appui qu'elle a trouvés ici, chez nous, au Centre de bien-être de L'espoir, c'est la vie.

www.youtube.com/watch?v=PkubWMt62KU
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6 days ago

Hope & Cope

Motivational Mondays. ... See MoreSee Less

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1 week ago

Hope & Cope

We were pleased to welcome a group of professors and students from the Faculty of Nursing, Chulalongkorn University in Bangkok, Thailand, who visited our Wellness Centre while in town for the 22nd International Palliative Care Congress, October 2-5. The group, escorted by Fay Strohschein, Doctoral Candidate in the Ingram School of Nursing at McGill University, included Dr. Sureeporn Tanasilp, Dr. Ratchaneekorn Upasen, Dr. Noppamat Pudtong, Dr. Weeraphol Saengpanya , Cdr. Dr. Kanoklekha Suwannapong (Postdoctoral fellow) and Supanee Klungrit (PhD Candidate). ... See MoreSee Less

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1 week ago

Hope & Cope

We are pleased to be hosting this important information session at our Cancer Wellness Centre next week. Space is limited, so please register early!

Veuillez noter que cette conférence sera donnée en anglais mais les questions en français seront bien reçues.

CIUSSS Centre-Ouest Montréal / CIUSSS West-Central MontrealWe will be hosting a free Colorectal Cancer Patient Information Session on October 17th at the JGH Hope & Cope Wellness Centre in Montreal. We will have leading experts in colorectal cancer treatment present content in the areas of Pathology, Medical and Surgical Oncology and Genetics to patients and caregivers.

To register to this free session: bit.ly/2EbhGWJ

For more information, please contact Frank Pitman at 514-875-7745 ext.2529 or frankp@colorectalcancercanada.com.
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