Near North Palliative Care Network

A Special Thanks to:

Assante

Caisse Populaire North Bay limitée

North Bay & Area Community Foundation

IBM Canada Ltd

North Bay Cruisers

Dr. Ken Runciman

United Way Toronto

Knights of Columbus 1007

Rebuilt Resources Skills Development Inc.

Northern Business Solutions

Mac's Office Supplies

Moose FM North Bay 106.5

Ohana Wellness Centre

Aha Communications

Boyd Print and Design

Chevaliers De Colomb #12101

Chevaliers De Colomb #8163

Hillside Funeral Homes

KFM North Bay

IODE Dr. Herbert A. Bruce Chapter

Widdifield Lions Club

Bonfield and District Lions Club

Northern Business Solutions

Widdifield Lions Club

Northern Business Solutions

A&A Entertainment

Aggies Flowers

Bell Canada Employee Giving Program

BEAM Blue Sky Net

Sofa Communications

Saint Peter's Church

Chip Kean and 22 Wing Band

The McCubbin family

Richard Smith, NBRHC Pastoral Care Team, and Palliative Care Committee

Miranda Weingartner

Gen McRae

Cheryl Gates, Respiratory Technician

Darren Renaud

Carol Owens

Marilyn Weingartner

Heather McGuinty, Case Coordinator for the CCAC

Bev Charron

Oriana Webster, NBRHC Volunteer Coordinator

Steve Lamb, Aids Committee

The Rheaume Rochefort Family

Jeff Johnson at Cambrian Technical Services

Volunteer Application Form

If you prefer a printed copy of our form, please click here.

Mr.Mrs.MissMs.

First Name:

Last Name:

Middle Name:

Home Phone:

Cell Phone:

Work Phone:

E-mail:

FAX #:

Street Address:


Complement:


City:


Province:


Postal Code:

Date of Birth (Month/Day/Year):

Languages Spoken:
EnglishFrench
Other (specify):

Name of Emergency Contact:

Relationship:

Phone of Emergency Contact:

Highest Educational Level:
High SchoolCollegeUniversity
completeincomplete

Palliative Care Training Courses Taken:

Bereavement and Grief Training Courses Taken:

Resumé (copy and paste your Resumé here):

Resumé (upload your Resumé here):

Have you ever been convicted of a criminal offence for which a pardon has not been granted?
YesNo

Are you willing to agree to a Canadian Police information check?
YesNo

Are there any clients you would not wish to visit?
YesNo

If yes, explain.

Which of the following activities would you be willing to volunteer?

Client Work
Visiting with Palliative Clients/FamiliesOvernight RespiteWeekend RespiteHoliday and Seasons RespiteRecreational TherapyTherapeutic Support (animal therapy, music therapy, laugh therapy, colour therapy, therapeutic touch, etc)Anticipatory Grief
Your Line of Therapeutic Support (specify):
Bereavement and Grief Support:
Individual SessionsGroup Sessions

Non-Client Work
Administrative Work at the OfficeAdministrative Work from HomeWebsite MaintenanceNewsletter WriterSocial Media Communication (Facebook, Twitter, YouTube)Event PlanningGrants/ProposalsData Collection and StatisticsGeneral Work at the Office

Board and Committees
Community Engagement and FundraisingFinance and BudgetGovernance, By-Laws, Policies and ProceduresQuality Assurance, Staff and Volunteer ManagementSponsorships and AlliancesCorporate Strategy, Program Development and EvaluationSatellite Offices (Mattawa, Sturgeon Falls)Education and TrainingBoard of Directors

What prompted your interest in volunteering for Near North Palliative Care Network?

Where did you hear about our upcoming Volunteer Training (if applicable):
WebsiteFacebookTwitter
Other (specify)

Have you experienced the death of a relative or close friends in the past year?
YesNo
If yes, state relationship:

List three non-related people who will provide a reference for you, including one work-related and one volunteer coordinator (if applicable).

Reference #1

Name

Relationship

City

Province

Phone Number

Reference #2

Name

Relationship

City

Province

Phone Number

Reference #3

Name

Relationship

City

Province

Phone Number

I, undersigned, authorize my references to give information to Near North Palliative Care Network regarding my application to become a volunteer.

Connect with us

Main Office:
St. Joseph Motherhouse
2025 Main Street West
North Bay, ON  P1B 2X6
Phone: (705) 497-9239
1-800-287-9441
Fax: (705) 497-1039
Hours:
08:30-16:30 Monday-Friday
(closed for lunch between 12:00-13:00)

Mattawa Office:
(705) 744-3771 Fax: (705) 744-2787
West Nipissing Office:
(705) 753-5771  |  Fax: (705) 753-6130