Volunteer Registration Form. Fields marked with *are required.


* Title:
* First Name:
* Last Name:
* Address:
* City:
* Province:
* Postal Code:
* Phone home:
Phone work:
Cell phone:
* Emergency contact name: * Phone:

* 1. Do you have a valid driver's license? Yes No

2. Describe your work situation:

Working   Retired  Seeking Work  Student   Other:  

3. Please list present or previous volunteer experiences:

* 4. Why does volunteering with the Medicine Hat Women's Shelter Society interest you?

* 5. What special skills/training would you bring to the Medicine Hat Women's Shelter Society?

6. Do you speak any other languages? If yes, what languages?

7. Preferred age group to work with (check all that apply): Children Teens Adults

8. Medical/Physical Limitations we should know about?

* 9. Have you accessed the Medicine Hat Women's Shelter Society's services within the past 2 years?

Yes No

* 10. What times are you interested in volunteering?

MondayAM   PM   Eve  
TuesdayAM   PM   Eve  
WednesdayAM   PM   Eve  
ThursdayAM   PM   Eve  
FridayAM   PM   Eve  
SaturdayAM   PM   Eve  
SundayAM   PM   Eve  


* 11. Are you available on short notice? Yes   No  

* 12. Identify areas of interest: Check all that apply:

Board Member/Board of Directors Casino Children's Program Cooking/Baking Donations Fundraising/Special Events Housekeeping Other Reception

13. How did you hear about us?

MHWSS Website TV Radio Referred by friend / volunteer Referred by Volunteer Centre Other

* 14. List name and phone number of 3 references (not relatives):

Reference 1:
Reference 2:
Reference 3:

* 15. Permission to Conduct Reference Check:

I , hereby authorize the Medicine Hat Women's Shelter Society to contact the above references in connection with my application.

I understand that I will be required to complete a Police information check, child intervention check, oath of confidentiality, and an interview - all as part of the screening process.

*** The personal information you provide will be used only for the purposes of managing and administering the Medicine Hat Women's Shelter Society's volunteer program. It is protected by the privacy provisions of the Freedom of Information and Protect of Privacy Act. ***

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